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Showing posts with label CAD. Show all posts
Showing posts with label CAD. Show all posts
Monday, August 30, 2010
Diretriz de Revascularização Miocárdica da Sociedade Européia de Cardiologia.
Hot Line Actually Only Lukewarm
By Peggy Peck, Executive Editor, MedPage TodayPublished: August 29, 2010
STOCKHOLM -- Intracoronary bone marrow cell transplantation extended survival in patients with chronic heart failure due to ischemic cardiomyopathy -- that was the good news. The bad news was that the finding was not "new" at all -- it had already been published.
Late today the European Society of Cardiology said it would sanction the researcher who reported the stem cell study by barring him from presenting research at ESC congresses for two years.
The ESC guidelines for Hot Line trials specifically state that the information submitted should be new, unpublished data. Yet, the STAR trial was accepted for presentation as a Hot Line trial at the ESC annual meeting here./.../
Monday, July 12, 2010
Cardiopulmonary Exercise Testing in Adults
(Circulation. 2010;122:191-225.)
© 2010 American Heart Association, Inc.
Gary J. Balady, MD, FAHA, Chair ; Ross Arena, PhD, FAHA ; Kathy Sietsema, MD ; Jonathan Myers, PhD, FAHA ;Lola Coke, RN, PhD ; Gerald F. Fletcher, MD, FAHA ; Daniel Forman, MD ; Barry Franklin, PhD, FAHA ;Marco Guazzi, MD, PhD ; Martha Gulati, MD ; Steven J. Keteyian, PhD ; Carl J. Lavie, MD ; Richard Macko, MD ;Donna Mancini, MD ; Richard V. Milani, MD, FAHA , on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention ;Council on Peripheral Vascular Disease ; Interdisciplinary Council on Quality of Care and Outcomes Research
Key Words: AHA Scientific Statements • diagnosis • exercise • heart failure • prognosis • exercise test • blood gas analysis
Exercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic informationregarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half centuryand, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing,adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function,and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testingprovides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians./.../
© 2010 American Heart Association, Inc.
AHA Scientific Statement |
Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults
A Scientific Statement From the American Heart Association
Key Words: AHA Scientific Statements • diagnosis • exercise • heart failure • prognosis • exercise test • blood gas analysis
 | Introduction |
|---|
Exercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic informationregarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half centuryand, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing,adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function,and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testingprovides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians./.../
Tuesday, June 08, 2010
Gout Drug Effective for Angina
Gout Drug, Allopurinol, Effective for Angina | ||||
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Saturday, June 05, 2010
The 1918 influenza and 20th century CHD
Journal of Developmental Origins of Health and Disease Cambridge University Press
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2010
doi:10.1017/S2040174410000292
Letter to the Editor
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Correspondence:
Dear Editor,
As a medical doctor studying, since 1990, the role of influenza as a determinant of the 20th century rise in CHD mortality, I welcome the publication in this journal of other papers also suggesting an association between the 1918 influenza pandemic and CVD occurrence.1
While our target birth cohorts and methodology were different, the underlining idea behind our studies was the same: that influenza priming would have a role in the differential birth cohort distribution of CHD and CVD events later in life./.../
Tuesday, January 15, 2008
2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee
A primary challenge in the development of clinical practice guidelines is keeping pace with the stream of new data upon which recommendations are based. In an effort to respond more quickly to new evidence, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has created a new "focused update" process to revise the existing guideline recommendations that are affected by evolving data or opinion. Before the initiation of this focused approach, periodic updates and revisions of existing guidelines required up to 3 years to complete. Now, however, new evidence will be reviewed in an ongoing fashion to more efficiently respond to important science and treatment trends that could have a major impact on patient outcomes and quality of care. Evidence will be reviewed at least twice a year, and updates will be initiated on an as needed basis as quickly as possible, while maintaining the rigorous methodology that the ACC and AHA have developed during their more than 20 years of partnership.
These updated guideline recommendations reflect a consensus of expert opinion following a thorough review that consisted primarily of late-breaking clinical trials identified through a broad-based vetting process as important to the relevant patient population and of other new data deemed to have an impact on patient care (see Section 1.1 for details on this focused update). It is important to note that this focused update is not intended to represent an update based on a full literature review from the date of the previous guideline publication. Specific criteria/considerations for inclusion of new data include:
Friday, January 04, 2008
Mayo Clinic Risk Score for Percutaneous Coronary Intervention
Mayo Clinic Risk Score for Percutaneous Coronary Intervention Predicts In-Hospital Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery Mandeep Singh MD, MPH*, Bernard J. Gersh MB, ChB, Shuang Li MS, John S. Rumsfeld MD, John A. Spertus MD, MPH, Sean M. O’Brien PhD, Rakesh M. Suri MD, DPhil, and Eric D. Peterson MD, MPH
From the Division of Cardiovascular Diseases (M.S., B.J.G., R.M.S.), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (S.L., S.M.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; and Denver V A Medical Center (J.S.R.), Denver, Colo.
Background—Current risk models predict in-hospital mortality after either coronary artery bypass graft surgery or percutaneous coronary interventions separately, yet the overlap suggests that the same variables can define the risks of alternative coronary reperfusion therapies. Our goal was to seek a preprocedure risk model that can predict in-hospital mortality after either percutaneous coronary intervention or coronary artery bypass graft surgery.
Methods and Results—We tested the ability of the recently validated, integer-based Mayo Clinic Risk Score (MCRS) for percutaneous coronary intervention, which is based solely on preprocedure variables (age, creatinine, ejection fraction, myocardial infarction 24 hours, shock, congestive heart failure, and peripheral vascular disease), to predict in-hospital mortality among 370 793 patients in the Society of Thoracic Surgeons database undergoing isolated coronary artery bypass graft surgery from 2004 to 2006. For the Society of Thoracic Surgeons coronary artery bypass graft surgery population studied, the median age was 66 years (quartiles 1 to 3, 57 to 74 years), with 37.2% of patients 70 years old. A high prevalence of comorbid conditions, including diabetes mellitus (37.1%), hypertension (80.5%), peripheral vascular disease (15.3%), and renal disease (creatinine 1.4 mg/dL; 11.8%), was present. A strong association existed between the MCRS and the observed mortality in the Society of Thoracic Surgeons database. The in-hospital mortality ranged between 0.3% (95% confidence interval 0.3% to 0.4%) with a score of 0 on the MCRS and 33.8% (95% confidence interval 27.3% to 40.3%) with an MCRS score of 20 to 24. The discriminatory ability of the MCRS was moderate, as measured by the area under the receiver operating characteristic curve (C-statistic=0.715 to 0.784 among various subgroups); performance was inferior to the Society of Thoracic Surgeons model for most categories tested.
Conclusions—This model, which is based on 7 preprocedure risk variables, may be useful for providing patients with individualized, evidence-based estimates of procedural risk as part of the informed consent process before percutaneous or surgical revascularization.
From the Division of Cardiovascular Diseases (M.S., B.J.G., R.M.S.), Mayo Clinic, Rochester, Minn; Duke Clinical Research Institute (S.L., S.M.O., E.D.P.), Durham, NC; Mid America Heart Institute/UMKC (J.A.S.), Kansas City, Mo; and Denver V A Medical Center (J.S.R.), Denver, Colo.
Background—Current risk models predict in-hospital mortality after either coronary artery bypass graft surgery or percutaneous coronary interventions separately, yet the overlap suggests that the same variables can define the risks of alternative coronary reperfusion therapies. Our goal was to seek a preprocedure risk model that can predict in-hospital mortality after either percutaneous coronary intervention or coronary artery bypass graft surgery.
Methods and Results—We tested the ability of the recently validated, integer-based Mayo Clinic Risk Score (MCRS) for percutaneous coronary intervention, which is based solely on preprocedure variables (age, creatinine, ejection fraction, myocardial infarction 24 hours, shock, congestive heart failure, and peripheral vascular disease), to predict in-hospital mortality among 370 793 patients in the Society of Thoracic Surgeons database undergoing isolated coronary artery bypass graft surgery from 2004 to 2006. For the Society of Thoracic Surgeons coronary artery bypass graft surgery population studied, the median age was 66 years (quartiles 1 to 3, 57 to 74 years), with 37.2% of patients 70 years old. A high prevalence of comorbid conditions, including diabetes mellitus (37.1%), hypertension (80.5%), peripheral vascular disease (15.3%), and renal disease (creatinine 1.4 mg/dL; 11.8%), was present. A strong association existed between the MCRS and the observed mortality in the Society of Thoracic Surgeons database. The in-hospital mortality ranged between 0.3% (95% confidence interval 0.3% to 0.4%) with a score of 0 on the MCRS and 33.8% (95% confidence interval 27.3% to 40.3%) with an MCRS score of 20 to 24. The discriminatory ability of the MCRS was moderate, as measured by the area under the receiver operating characteristic curve (C-statistic=0.715 to 0.784 among various subgroups); performance was inferior to the Society of Thoracic Surgeons model for most categories tested.
Conclusions—This model, which is based on 7 preprocedure risk variables, may be useful for providing patients with individualized, evidence-based estimates of procedural risk as part of the informed consent process before percutaneous or surgical revascularization.
Perinatal Risk Factors for Ischemic Heart Disease. Disentangling the Roles of Birth Weight and Preterm Birth
Perinatal Risk Factors for Ischemic Heart Disease. Disentangling the Roles of Birth Weight and Preterm Birth Magnus Kaijser MD, PhD*, Anna-Karin Edstedt Bonamy MD, Olof Akre MD, PhD, Sven Cnattingius MD, PhD, Fredrik Granath PhD, Mikael Norman MD, PhD, and Anders Ekbom MD, PhD
From the Clinical Epidemiology Unit, Department of Medicine (M.K., O.A., F.G., A.E.), Department of Woman and Child Health (A.-K.E.B.), Department of Medical Epidemiology and Biostatistics (S.C.), and Department of Clinical Science, Intervention, and Technology (M.N.), and Department of Clinical Sciences at Danderyds Hospital (M.K.), Karolinska Institutet, Stockholm, Sweden.
* To whom correspondence should be addressed. E-mail: magnus.kaijser@ki.se
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.
Background—Several studies have reported an association between low birth weight and ischemic heart disease, but it remains unclear whether the association is mediated through poor fetal growth or short gestational duration.
Methods and Results—In a cohort study, we have identified all subjects born preterm or with a low birth weight at 4 major delivery units in Sweden from 1925 through 1949. For comparison, an equal number of subjects with none of these criteria were identified within the same source population. The study population consists of 6425 subjects, of whom 2931 were born before 37 weeks of gestation and 2176 had a birth weight <2500 g. Fetal growth was estimated through birth weight for gestational age. The cohort was followed up for occurrence of ischemic heart disease through the nationwide Hospital Discharge and Cause of Death Registries during the period of 1987 through 2002. In the cohort, 617 cases of ischemic heart disease occurred. Compared with subjects with a normal fetal growth, those born small for gestational age (birth weight -2 SD below the mean) were at increased risk of ischemic heart disease (adjusted hazard ratio, 1.64; 95% confidence interval, 1.23 to 2.18). The negative association between fetal growth and risk of ischemic heart disease was independent of gestational duration.
Conclusions—The association between low birth weight and adult risk of ischemic heart disease appears to be mediated entirely by poor fetal growth.
From the Clinical Epidemiology Unit, Department of Medicine (M.K., O.A., F.G., A.E.), Department of Woman and Child Health (A.-K.E.B.), Department of Medical Epidemiology and Biostatistics (S.C.), and Department of Clinical Science, Intervention, and Technology (M.N.), and Department of Clinical Sciences at Danderyds Hospital (M.K.), Karolinska Institutet, Stockholm, Sweden.
* To whom correspondence should be addressed. E-mail: magnus.kaijser@ki.se
'//-->
.
Background—Several studies have reported an association between low birth weight and ischemic heart disease, but it remains unclear whether the association is mediated through poor fetal growth or short gestational duration.
Methods and Results—In a cohort study, we have identified all subjects born preterm or with a low birth weight at 4 major delivery units in Sweden from 1925 through 1949. For comparison, an equal number of subjects with none of these criteria were identified within the same source population. The study population consists of 6425 subjects, of whom 2931 were born before 37 weeks of gestation and 2176 had a birth weight <2500 g. Fetal growth was estimated through birth weight for gestational age. The cohort was followed up for occurrence of ischemic heart disease through the nationwide Hospital Discharge and Cause of Death Registries during the period of 1987 through 2002. In the cohort, 617 cases of ischemic heart disease occurred. Compared with subjects with a normal fetal growth, those born small for gestational age (birth weight -2 SD below the mean) were at increased risk of ischemic heart disease (adjusted hazard ratio, 1.64; 95% confidence interval, 1.23 to 2.18). The negative association between fetal growth and risk of ischemic heart disease was independent of gestational duration.
Conclusions—The association between low birth weight and adult risk of ischemic heart disease appears to be mediated entirely by poor fetal growth.
Wednesday, December 05, 2007
Adolescent Overweight and Future Adult Coronary Heart Disease
Kirsten Bibbins-Domingo, Ph.D., M.D., Pamela Coxson, Ph.D., Mark J. Pletcher, M.D., M.P.H., James Lightwood, Ph.D., and Lee Goldman, M.D., M.P.H.
Background The effect of adolescent overweight on future adult coronary heart disease (CHD) is not known.
Methods We estimated the prevalence of obese 35-year-olds in 2020 on the basis of adolescent overweight in 2000 and historical trends regarding overweight adolescents who become obese adults. We then used the CHD Policy Model, a state-transition computer simulation of U.S. residents who are 35 years of age or older, to project the annual excess incidence and prevalence of CHD, the total number of excess CHD events, and excess deaths from both CHD and other causes attributable to obesity from 2020 to 2035. We also modeled the effect of treating obesity-related increases in blood pressure and dyslipidemia.
Results Adolescent overweight is projected to increase the prevalence of obese 35-year-olds in 2020 to a range of 30 to 37% in men and 34 to 44% in women. As a consequence of this increased obesity, an increase in the incidence of CHD and in the total number of CHD events and deaths is projected to occur in young adulthood. The increase is projected to continue in both absolute and relative terms as the population reaches middle age. By 2035, it is estimated that the prevalence of CHD will increase by a range of 5 to 16%, with more than 100,000 excess cases of CHD attributable to the increased obesity. Aggressive treatment with currently available therapies to reverse modifiable obesity-related risk factors would reduce, but not eliminate, the projected increase in the number of CHD events.
Conclusions Although projections 25 or more years into the future are subject to innumerable uncertainties, extrapolation from current data suggests that adolescent overweight will increase rates of CHD among future young and middle-aged adults, resulting in substantial morbidity and mortality.
Background The effect of adolescent overweight on future adult coronary heart disease (CHD) is not known.
Methods We estimated the prevalence of obese 35-year-olds in 2020 on the basis of adolescent overweight in 2000 and historical trends regarding overweight adolescents who become obese adults. We then used the CHD Policy Model, a state-transition computer simulation of U.S. residents who are 35 years of age or older, to project the annual excess incidence and prevalence of CHD, the total number of excess CHD events, and excess deaths from both CHD and other causes attributable to obesity from 2020 to 2035. We also modeled the effect of treating obesity-related increases in blood pressure and dyslipidemia.
Results Adolescent overweight is projected to increase the prevalence of obese 35-year-olds in 2020 to a range of 30 to 37% in men and 34 to 44% in women. As a consequence of this increased obesity, an increase in the incidence of CHD and in the total number of CHD events and deaths is projected to occur in young adulthood. The increase is projected to continue in both absolute and relative terms as the population reaches middle age. By 2035, it is estimated that the prevalence of CHD will increase by a range of 5 to 16%, with more than 100,000 excess cases of CHD attributable to the increased obesity. Aggressive treatment with currently available therapies to reverse modifiable obesity-related risk factors would reduce, but not eliminate, the projected increase in the number of CHD events.
Conclusions Although projections 25 or more years into the future are subject to innumerable uncertainties, extrapolation from current data suggests that adolescent overweight will increase rates of CHD among future young and middle-aged adults, resulting in substantial morbidity and mortality.
Wednesday, June 20, 2007
Calcified plaque x estrogens
JoAnn E. Manson, M.D., et al NEJM
Background Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.
Methods In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.
Results The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.
Conclusions Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611 [ClinicalTrials.gov] .)
Background Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.
Methods In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.
Results The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.
Conclusions Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611 [ClinicalTrials.gov] .)
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