Keeping you up to date on recent headlines in cardiovascular healthcare:
Doctors try non-surgical technique to tie off LAA ... Doctors at The Mount Sinai Medical Center (Miami Beach, Florida) performed a non-surgical procedure last week using sutures to tie off a left atrial appendage (LAA), which according to the hospital is the source of blood clots leading to stroke in patients with atrial fibrillation (AF). Vivek Reddy, MD, professor of medicine and director of the Cardiac Arrhythmia Service at Mount Sinai Heart, and his colleague, Srinivas Dukkipati, MD, director of Mount Sinai's Experimental Electrophysiology Laboratory, performed the procedure. The physicians guided two catheters into the patient's heart to seal the LAA with a pre-tied suture loop. The technique is a safe alternative to drug therapies such as the blood thinner warfarin that can have serious side effects, as well as open-heart surgery, and more invasive implant surgery, Mount Sinai noted. Reddy and Dukkipati joined Mount Sinai this month to focus on building the institution's services for heart-rhythm disorders. They had been performing pre-clinical testing of the non-surgical LAA device, and this procedure represents its first application in people in the U.S., according to Mount Sinai. SentreHeart (Palo Alto, California) developed the Lariat suture delivery device, which was approved by the FDA in May. The procedure was performed in a cardiac catheterization laboratory and did not require cardiopulmonary bypass, Mount Sinai noted.
Pessimism is bad for the heart, study finds ... Optimism reduces heart risk in women, according to a recent U.S. study published in the journal Circulation. The research on nearly 100,000 women, found pessimists had higher blood pressure and cholesterol. Optimistic women had a 9% lower risk of developing heart disease and a 14% lower risk of dying from any cause after more than eight years of follow-up, the study showed. In comparison, cynical women who harbored hostile thoughts about others or were generally mistrusting of others were 16% more likely to die over the same time-scale. In the study, the optimistic women exercised more and were leaner than pessimistic peers, the authors noted. "The majority of evidence suggests that sustained, high degrees of negativity are hazardous to health," said Hilary Tindle, MD, lead researcher and assistant professor of medicine at the University of Pittsburgh.
Study shows chocolate may lower blood pressure ... Scientists in Sweden found that chocolate eaters in a study of heart attack survivors had lower blood pressure and were less likely to die of heart disease. Of the 1,169 patients studied, those who ate chocolate two or more times a week cut their risk of dying from heart disease nearly threefold compared to those who didn't eat chocolate at all, said the study's lead author, Imre Janszky, MD, of Karolinska Institute (Stockholm, Sweden). The findings are expected to be published in the September issue of the Journal of Internal Medicine. The study suggested smaller quantities of chocolate granted lower levels of heart protection, but were still better than not eating it at all. The research built upon earlier work, which suggested a strong link between cocoa-based products and improvement in blood flow.
CTCA useful in predicting freedom from cardio events ... Computed tomographic coronary angiography (CTCA) appears extremely useful in predicting freedom from cardiovascular events in lower-risk patients, which could cut down on more costly invasive angiography, according to research published in the Aug. 15 issue of the American Journal of Cardiology. Poorya Fazel, MD, of the Baylor University Medical Center (Dallas), and colleagues analyzed data from 436 patients with chest pain thought to be anginal, who were considered at low risk for significant flow-limiting coronary artery disease and who underwent 64-slice CTCA. Of these patients, the researchers found 376 to have minimal or no coronary artery disease on CTCA, and all of these patients remained free of cardiovascular events or interventions at 36 months of follow-up. Sixty of the patients were thought to have flow-limiting coronary artery disease on CTCA, of which 57% went on to have percutaneous coronary intervention or coronary artery bypass grafting. The authors wrote that, "In a real-world, clinical setting, the negative predictive value of low-risk CTCA is very high and exceptionally helpful in predicting freedom from events for up to three years."
Heart failure prognosis predicted by UACR, says UK study ... According to an article published in The Lancet, written by John McMurray of the British Heart Foundation Cardiovascular Research Center at the University of Glasgow, UK and colleagues, the ratio of albumin to creatine in a person's urine is a powerful and independent predictor of prognosis of heart failure. According to the article, increased excretion of albumin in urine is an established risk factor for mortality, cardiovascular events, and kidney disease in the general population, and in patients with diabetes, high blood pressure, and other types of cardiovascular disease. In this study, the authors aimed to assess the prognostic value of a spot urinary albumin to creatine ratio (UACR) in patients with heart failure, using date from the Candersartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. UACR was measured at baseline and during follow up of 2,310 patients. Patients were diagnosed as having very high albumin excretion (macroalbuminuria), less serious excretion (microalbuminuria) or normoalbuminuria. The researchers found 58% patients had normal UACR, 30% had microalbuminuria, and 11% had macroalbuminuria. The prevalence of increased UACR was similar in patients with reduced and preserved left ventricular ejection fractions (a measure of heart function), the authors said. Patients with increased UACR were older, had more cardiovascular disease, worse kidney function, and a higher prevalence of diabetes than did those with normoalbuminuria, they noted. However, a high prevalence of UACR was still noted in heart failure patients without diabetes, high blood pressure, or kidney disease. Higher UACR was associated with increased risk of death from cardiovascular causes or admission to hospital with worsening heart failure (the combined end point of the CHARM study), even after adjustment for kidney function, and diabetes/blood glucose status. Patients with microalbuminuria were 43% more likely to reach the combined end point than those with normal UACR; patients with macroalbuminuria were 75% more likely to reach the combined end point than those with normal UACR. When looking specifically at death due to cardiovascular causes, patients with microalbuminuria were 62% more likely to die from this cause than those with normal UACR, which rose to 76% more likely for patients with macroalbuminuria.
Expectant mothers told not to use fetal heart monitors ... It's tempting for a mother-to-be to want to listen to their baby's heartbeat at home using a personal monitor (Doppler device), but according to an article in the British Medical Journal doing so may lead to delays in seeking help for reduced fetal movements. In the article, Thomas Aust, MD, and colleagues from the department of obstetrics and gynecology at Arrowe Park Hospital (Wirral, UK), described the case of a 27-year-old who presented to her labor ward 32 weeks into her first pregnancy with reduced fetal movements. She had first noted a reduction in her baby's activity two days earlier but had used her own Doppler device to listen to the heartbeat and reassured herself that everything was normal. Further monitoring by the antenatal care team was not reassuring and the baby was delivered by caesarean section later that evening. The baby remained on the special care baby unit for eight weeks and is making steady progress, according to the BMJ article. A hand-held Doppler device assesses the presence of fetal heart pulsations only at that moment, and it is used by midwives and obstetricians to check for viability or for intermittent monitoring during labor, the authors said. In untrained hands it is more likely that blood flow through the placenta or the mother's main blood vessels will be heard, they noted.
— Compiled by Amanda Pedersen, MDD