Keeping you up to date on recent headlines in cardiovascular healthcare:
Study reveals prognostic value of T-wave parameters ... New research published in the August edition of the Heart Rhythm Journal, the journal of the Heart Rhythm Society (Washington) reveals T-wave morphology parameters contain predictive value for mortality in the general population, independent of other clinical risk factors. The study indicates that T-wave morphology parameters may allow healthcare professionals to better assess arrhythmia vulnerability in patients, and the prognostic value is uniquely related to cardiovascular mortality and seems to be gender specific. The study, led by Kimmo Porthan, MD, Department of Cardiology at Helsinki University Central Hospital in Finland, aims to equip health professionals with a dependable prognosis tool that has never been available through traditional electrocardiographic QT intervals. According to the journal, the study was the largest of its kind and conducted by assessing 5,917 adults participating in the Finnish population-based Health 2000 study. T-wave morphology parameters measure abnormalities during the ventricular repolarization phase and are potentially interrelated with arrhythmia vulnerability. As researchers learn more, T-wave morphology parameters may eventually help health professionals select specific treatment strategies, the study authors said.
New criteria, tests, needed to diagnose ARVC/D ... A new study, published last month in the HeartRhythm Journal, points to the need for a revision of criteria to effectively evaluate the presence of right ventricular structural, functional and electrical abnormalities. The study analyzed the clinical characteristics and diagnostic evaluation including genetic testing of a large group of patients newly identified with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). The study is the largest of its kind, according to the journal, and included more than 100 newly diagnosed ARVC/D patients. ARVC/D is a genetic cardiomyopathy characterized by ventricular arrhythmias and structural abnormalities of the right ventricle. In ARVC/D there is a progressive replacement of right ventricular myocardium with fatty and fibrous tissue and ventricular arrhythmias of right ventricular origin. The precise prevalence of the disease is relatively uncommon but may account for up to 20% of cases of sudden death among young individuals, according to the journal. From 2001 to 2008, the North American Multidisciplinary Study led by Frank Marcus, MD, of the section of cardiology at the University of Arizona (Tucson), enrolled a total of 108 newly diagnosed patients with suspected ARVC/D in 18 centers within the U.S. and Canada. The patients underwent noninvasive and invasive tests using standardized protocols that were initially interpreted by the enrolling center and then adjudicated by blind analysis in six core laboratories. According to the authors, the results of the study reveal a significant difference in the clinical profile of newly diagnosed patients versus the profile of those patients who have been reported with advanced stages of the disease. There was also a considerable difference in the initial and final classification of the presence of ARVC/D after diagnostic tests were evaluated by the core laboratories. This study substantiates the need for multiple diagnostic tests as well as updated, more well-defined criteria for diagnosing the disease, the authors noted.
Study examines link between CAD, depression, in twins ... Major depression and coronary artery disease (CAD) are only modestly related throughout an individual's lifetime, but studying how the two interact over time and in twin pairs paints a more complex picture of the associations between the conditions, according to a report in the August issue of Archives of General Psychiatry. For example, the association between CAD onset and major depression risk is much stronger over time than vice versa, according to the study. "While an association between major depression and coronary artery disease has long been noted and recently confirmed, the direction and cause of this association remain unclear," the authors write as background information in the article. High cortisol levels, inflammation and changes in blood platelet function associated with depression may increase risk for coronary artery disease; coronary artery disease is a stressful event that may increase risk for depression; and shared genetic or environmental factors may underlie both conditions. Kenneth Kendler, MD, of Virginia Commonwealth University School of Medicine (Richmond), and colleagues studied 30,374 twins (average age, 57) from the Swedish Twin Registry. Information was obtained from telephone interviews conducted between 1998 and 2003 and also from Swedish hospital discharge and death registers.
Experts call upon MDs to embrace guidance for post-MI ... Experts from the Primary Care Cardiovascular Society and HEART UK – the Cholesterol Charity, are calling upon primary care clinicians to embrace new guidance designed to support optimal care and treatment of post-myocardial infarction (MI) patients. Published in the latest issue of the British Journal of Cardiology, the guidance is unique as it is aligned to both patients and primary care, thereby recognizing the vital role of empowering patients and their families in achieving the best possible clinical outcomes. The guidance was developed collaboratively by primary and secondary care clinicians in response to an unmet need for clear, consistent and practical recommendations to support general physicians and practice nurses in the management of the 1.4 million post-MI survivors across the UK.
Methods for heart failure diagnoses in UK reviewed ... A blood test (BNP) should be recommended over an electrocardiogram (ECG) for the diagnosis of heart failure, according to research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) program. Heart failure is associated with significant morbidity, mortality, and healthcare expenditure. There is however, a good evidence base for interventions to improve prognosis, although the diagnosis of heart failure in primary care is often inaccurate. Current recommendations are that patients in whom heart failure is suspected should undergo ECG and/or BNP. If either of these is positive, they should then be referred for echocardiography as part of their diagnostic work-up. The study led by Jonathan Mant, a professor at the University of Cambridge, reviewed existing evidence to determine the best way for primary care physicians to diagnose heart failure in the UK. From their findings the research team have developed a simple clinical rule: patients who present with symptoms such as breathlessness and in whom heart failure is suspected should be referred directly to echocardiography if they have: a history of MI, basal crepitations, or are male and have ankle edema. Otherwise a BNP test should be conducted initially, and depending on these results, then referred for echocardiography.
Less is more, blood transfusion study says ... A new study suggests that blood transfusions for hospitalized cardiac patients should be a last resort because they double the risk of infection and increase by four times the risk of death. The analysis of nearly 25,000 Medicare patients in Michigan also showed that transfusion practices after heart surgery varied substantially among hospitals, a red flag that plays into the healthcare reform debate. According to study co-author Neil Blumberg, MD, professor of Pathology and Laboratory Medicine and director of Transfusion Medicine at the University of Rochester Medical Center, blood transfusion is an area that could be well served with stronger, research-based guidelines, since the current clinical practice is all over the map. "Doctors are simply doing what they were trained to do, but it turns out that their actions are more harmful than helpful in many cases," Blumberg said. "This is an instance in which clinical practice got way ahead of research. And changing the liberal use of transfusions is going to be difficult despite the evidence showing it is usually not essential." The study was published July 31 in the journal BMC Medicine. It was designed to assess patient outcomes as well as hospital variation in blood use.
— Compiled by Amanda Pedersen, MDD