Keeping you up to date on recent headlines in cardiovascular healthcare:
Reports from the annual meeting of the American Roentgen Ray Society (Leesburg, Virginia) in Boston, April 26-30:
Cardiac CT better, cheaper for low-risk chest pain in ER .... Cardiac CT to diagnose low-risk patients with chest pain is 44% less costly than the standard of care and can decrease the length of hospital stay up to 20 hours, according to a study performed at the University of Washington (Seattle). Fifty-three patients were compared using results from a cardiac CT-based workup and a traditional standard-of-care workup using nuclear stress testing. "With new, lower-dose cardiac CT options available that lower the patient radiation dose, patients get a faster evaluation and are discharged much sooner with a cardiac CT; in less than six hours," said one of the lead researchers. The study was presented yesterday at the annual meeting of the American Roentgen Ray Society (Leesburg, Virginia) in Boston.
Hypertension, diabetes, carotid artery wall thickness increases risk of stroke .... Increased carotid artery wall thickness (CAWT) is significantly related to diabetes and hypertension, according to a study performed at A.O.U. (Cagliari Sardegna, Italy). In this study, 186 patients were evaluated using multidetector row CT to see if CAWT is associated with cardiovascular risk factors, the data showing a statistically significant relationship between diabetes and hypertension. "There was no significant statistical correlation between the increase of carotid wall thickness, smoking and dyslipidemia," said Luca Saba, MD, lead author of the study.
CCTA aids coronary CT angiography .... A new automated system used to interpret coronary CT angiography (CCTA) helps radiologists determine which cases are high priority and should be read first, according to a study performed at Thomas Jefferson University (Philadelphia). The study included 100 CCTA studies using the automated system (COR Analyzer II Software). "The software detected 10/13 patients with artery stenosis 50% or greater and correctly identified 59/80 patients with less than 50% artery stenosis," said Shaoxiong Zhang, MD, lead study author. (www.arrs.org)
Prisoners face high risk for heart disease .... Prison inmates are not just at increased risk for infectious diseases like HIV, as previous studies have shown, but also for heart-related conditions, according to research from Yale University (New Haven, Connecticut) and the University of California San Francisco. The researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study and found that black men and less educated participants, who were most likely to have history of prior incarceration, showed the most pronounced association between hypertension and incarceration. The association persisted after adjusting for factors such as substance abuse, race, poverty and prior health. Another factor was the availability of healthcare in prison. The study was published in the Archives of Internal Medicine. (www.yaledailynews.com/articles/view/28897)
UK report: Quarter of stroke patients not receiving best treatment .... The National Sentinel Audit for Stroke 2008 reports that one-quarter of the patients studied in the UK were not offered the best treatment for stroke, a stay in a dedicated stroke unit. The audit covers 100% of eligible hospitals in England, Wales and Northern Ireland. Among the findings: 29% of patients were admitted to a stroke unit on the same day as their stroke and 57% were admitted either the same day or the following day, a major improvement; only 17% of patients are admitted to an acute stroke unit within four hours of admission; only 21% of patients had a brain scan within three hours, where appropriate, an improvement over the 16% figure in 2006, "but nowhere near high enough if patients are to receive the best outcomes;" although more centers are providing anti blood-clotting drug, less than 10% of appropriate patients are receiving the drug nationally; a "worrying number of patients are being moved into nursing homes directly from hospital. 2%, or 82 out of 4432 patients discharged within two weeks of a stroke were admitted to care or residential homes. (www.rcplondon.ac.uk/news/news.asp?PR_id=450)
Study: higher risk of heart disease with removal of ovaries .... Women who undergo a bilateral oophorectomy, the removal of both ovaries, during a hysterectomy have a higher risk of death, including death from coronary heart disease and lung cancer, than women who keep their ovaries, The findings contradict the long-held belief that removing ovaries during a hysterectomy produces the highest chance of long-time survival. The study examined data on 29,380 women from the national Nurse's Health Study, which analyzed the health of 122,700 female registered nurses ages 30 to 55 since 1976. Of the 29,380 participants, 16,345 had hysterectomies that included ovary removal, while 13,035 had hysterectomies that did not include ovary removal. The study appears in the May issue of Obstetrics and Gynecology. (www.nationalpartnership.org)
Blood vessels from kidney patients' own cells used in dialysis .... U.S. researchers at Cytograft (Novato, Calilfornia) report development of a new way of growing blood vessels using a patient's own skin cells to seed the growth of tissue, tested in dialysis patients with end stage kidney disease. The researchers recruited 10 patients with end-stage kidney disease who had been having dialysis through an access graft nearing failure and had experienced at least one access failure. Five patients had grafts functioning for haemodialysis six to 20 months after implantation. The vessels were made from two types of skin cell from each patient: fibroblasts for scaffolding and endothelial cells for making the lining of the blood vessel tissue. Preliminary results of the trial appear in the April 25 online issue of The Lancet (Vol. 373, Issue 9673). An accompanying editorial called the method promising but expensive, with anticipated costs in the region of $15,000 to $20,000. (www.cytograft.com/contact.html)
Study: muscular counterpulsation after coronary bypass grafting .... A study titled "Therapeutic Value of Muscular Counterpulsation After Coronary Bypass Grafting Operation" demonstrates that muscular counterpulsation (MCP) represents a noninvasive, ECG-triggered circulation support system, effective for achieving hemodynamic improvement via afterload reduction. In 50 patients undergoing CABG, a treatment group of 30 patients received MCP treatment for 30 minutes daily for the eight initial postoperative days in addition to standard therapy and had a 36% decrease in systemic vascular resistance (vs. 16% in control group). The m.pulse device made by Cardiola (Winterthur, Switzerland), based on MCP technology, is approved in Europe for treating CHF as a nonsurgical, at-home therapy. The study appears in the Journal of Cardiac Surgery (2009;24:134-140). (www.cardiola.com/home.html?L=1)
Key enzyme identified that produces fibrous heart tissue .... Scientists at the Center for Applied Medical Research of the University of Navarra (Navarra; Spain) say they have identified a key enzyme in the accumulation of fibrous tissues in the hearts of patients with chronic cardiac diseases and deterioration of heart functions. The researchers analyzed the expression of Llysyl oxidase, an enzyme which regulates the amount of fibrous tissue in cardiac muscle. "By means of molecular and histological methods, we have found that the cardiac muscle in patients with cardiac insufficiency contains an excess of this enzyme as well as collagen fiber. These factors are associated with the deterioration of cardiac functions," said Bego a L pez, MD, lead project researcher. The research is published in the journal Hypertension. (http://hyper.ahajournals.org/current.dtl)
— Compiled by Don Long, MDD National Editor