Keeping you up to date on recent headlines in cardiovascular healthcare:
Mixed results with stress echo in menopausal women .... Preliminary results of a new study show that contrast stress echocardiography demonstrated sensitivity for coronary atherosclerosis in women in early menopause but poor specificity and no correlation with lab parameters. As verified by coronary angiography, contrast stress echocardiography had a sensitivity of 80% for coronary disease, but specificity was less than half that, Sharon Mulvagh, MD, of the Mayo Clinic (Rochester, Minnesota), reported at this week's annual meeting of the American Society of Echocardiography (ASE; Morrisville, North Carolina) in Washington. Mulvagh reported that 42 women (11.5%) had abnormal contrast stress echo tests. Additionally, 22 (6%) had positive ECG tests, and 23 (6.2%) had indeterminate or inadequate ECG results.
Patients not receiving appropriate aortic valve replacement .... Another study at the scientific sessions of the ASE said that symptoms of severe aortic stenosis are under-diagnosed, many patients not receiving aortic valve replacement surgery, according to research unveile. By using cardiovascular ultrasound and other objective tests, physicians can more accurately diagnose symptoms of severe aortic stenosis and help prevent the rapid progression of the disease. The researchers said that only 25% of 106 patients with severe aortic stenosis (AS) were referred for surgery. The others did not have valve replacement surgery even though they met echocardiographic criteria.
Project reduces radiation in heart scans .... A joint quality improvement project among Michigan hospitals has been reported as cutting by more than half the amount of radiation used in CT angiography scans of the heart and blood vessels, with no effect on image quality. The initiative – for scans of about 5,000 patients – involved 15 hospitals of all sizes, with radiation reduced an average of 53.3%, to about three years' "background radiation." The project received financial support from Blue Cross Blue Shield of Michigan and Blue Care Network. Project details appear in the June 10 issue of the Journal of the American Medical Association. (www.bcbsm.com/pr/pr_06-09-2009_33015.shtml)
Study: Lack of sleep boosts risk of high BP .... Middle-aged adults who routinely get less than seven or eight hours of sleep a night are at risk for high blood pressure (BP), according to a study by researchers at the University of Chicago. For every hour of missed sleep, odds of developing the condition rose an average 37% over five years, said Kristen Knutson, PhD, lead author of the study. Skipping two hours sleep raised the blood pressure risk 86%. Researchers followed 578 adults, measuring how long each participant slept using a sensor on the wrist that chronicles rest and activity; 14% developed high BP during the five-year trial. The study, sponsored by the NIH, was part of a larger trial, the Coronary Artery Risk Development in Young Adults. The study appears in the June 8 issue of the Archives of Internal Medicine. (abstract: http://archinte.ama-assn.org/cgi/content/short/169/11/1055)
Stroke patients less compliant with treatment than heart patients.... A majority of high-risk stroke patients are less likely to meet clinical treatment targets to prevent repeat stroke or heart attacks compared to those with heart diseas, according to a study by researchers at St. Michael's Hospital (Toronto). The study followed 4,933 outpatients across Canada with a history of heart attack and stroke. About 30% of patients with heart disease achieved target BP and LDL-cholesterol levels. Only 20% of stroke patients met target BP and LDL-cholesterol levels. Among stroke patients, women were also less likely to meet the targets despite a similar treatment history. The researchers suggest that the gap is the result of differences in the emphasis of recommended targets between heart and stroke prevention guidelines. (www.stmichaelshospital.com/media/detail.php?source=editorial/articles/media/hospital_news/20090610_hn)
Response to carotid endarterectomy audit .... Joe Korner, director of communications at UK's The Stroke Association (London) said that a report indicating a lag in the treatment of transient ischemic attacks (TIAs) "shows that there is still a long way to go to make sure people get urgent preventative treatment that could prevent a catastrophic stroke." The audit shows that TIA patients experience unacceptable delays; from the onset of symptoms to diagnosis and GP referral to investigation to surgery, highlights variations in quality of care provision across the UK, and suggests a lack of cohesive referral pathways. "As people become more aware of stroke symptoms through the FAST advertising, it is vital that the NHS treats all types of stroke, including those with short-lived symptoms known as [TIAs], as emergencies when people call 999," Korner said. (www.stroke.org.uk/)
DES safe for elderly .... Drug-eluting stents (DES) were safe and effective for older patients, according to an analysis of data from five randomized trials and two post-market registries have shown. Patients older than 70 who received paclitaxel-eluting stents had rates of death, myocardial infarction, and stent thrombosis comparable to those receiving bare metal stents (BMS), but had a 54% lower rate of revascularization (22% vs. 10%, P<0.001), according to Daniel Forman, MD, of Brigham and Women's Hospital (Boston) and colleagues. The researchers pooled data from 2,271 patients who received paclitaxel-eluting DES in randomized trials and 7,492 patients who received DES in two real-world registries. They included 1,397 patients who received BMS in trials, to assess outcomes by stent type. Patients were divided into three groups according to age – younger than 60 years, 60 to 70, and older than 70. The rates of MI, stent thrombosis, and target lesion revascularization were comparable among all age groups, but DES-implanted patients had a significant reduction in rates of target lesion revascularization compared with those BMS-implanted.
Study underlines mechanical forces that build new blood vessels .... A research team at Uppsala University and its University Hospital (Uppsala, Sweden) has shown that mechanical forces are considerably more important in generating new blood vessels than previously thought. "[O]ur findings show that in wound healing, in-growth of new blood vessels takes place via mechanical forces that pull already existing blood vessels into the wound when it heals," said study director P r Gerwins. The study shows that wound contraction governs the in-growth of new blood vessels and suggests that a therapeutic strategy in tumors and rheumatic joints would be to block the contractive capacity of myofibroblasts and other connective tissues. The researchers said the model may partially explain the mechanism behind the benefit of "vacuum-assisted wound closure [VAC]." The findings appear in May 31 online issue of Nature Medicine.
(abstract: www.nature.com/nm/journal/v15/n6/abs/nm.1985.html) (www.uu.se/news/news_item.php?typ=pm&id=656)
Signs of heart damage in overweight male teens with normal BP ... . Even while their blood pressures are still normal, overweight male teens may have elevated levels of a hormone known to increase pressures as well as early signs of heart damage, researchers at the Medical College of Georgia (Augusta) say. Looking at 126 healthy 15- to 17-year-old high school students, they found the hormone aldosterone highest among the overweight males. Despite normal BPs, the overweight males had thickened heart walls and an increase in the size of the heart's pumping. Overweight females did not have elevated aldosterone levels or associated heart damage, perhaps because estrogen may have a cardio-protective effect, the researchers said. The research suggests that fat cells stimulate the adrenal glands to make more aldosterone, said Dr. Gregory Harshfield, director of MCG's Georgia Prevention Institute and a hypertension researcher.
— Compiled by Don Long, MDD National Editor