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Thursday, March 13, 2008

Gmail - MedWire Cardiology News - 13 March 2008

Gmail - MedWire Cardiology News - 13 March 2008

Plausible role for CAPON gene in QRT variationResearchers have shown cardiac expression and biologic effects of the CAPON protein, supporting its potential influence on QT interval variation in human populations.http://www.medwire-news.md/38/73666/Cardiology_News/Plausible_role_for_CAPON_gene_in_QRT_variation.html


Implantable pressure monitor fails to reduce HF-related eventsUse of an implantable continuous hemodynamic monitor to guide optimal medical management of patients with heart failure failed to significantly reduce rates of HF-related events, report researchers.http://www.medwire-news.md/38/73667/Cardiology_News/Implantable_pressure_monitor_fails_to_reduce_HF-related_events.html


No evidence of link between bisphosphonates and AF, flutterScientists have found no evidence to suggest that use of bisphosphonates increases the risk for atrial fibrillation and flutter.http://www.medwire-news.md/38/73668/Cardiology_News/No_evidence_of_link_between_bisphosphonates_and_AF,_flutter.html

Wednesday, March 12, 2008

Migraine Intervention With STARFlex Technology (MIST)

Summary

Posted: 3/10/2008

Writer: Anthony A. Bavry, M.D., M.P.H.

Description

The goal of this trial was to evaluate closure of patent foramen ovale (PFO) compared with a sham procedure in patients with refractory migraine headache.

Hypothesis

Closure of a PFO with the STARFlex device will be more effective in reducing migraine headache.

Drugs/Procedures Used

After general anesthesia, patients underwent transesophageal echocardiography to assess the interatrial septal anatomy. Patients were then randomized to PFO closure (n = 74) or a sham procedure that consisted of a skin incision (n = 73).

Concomitant Medications

Patients received aspirin (300 mg) and clopidogrel (300 mg) 24 hours prior to the procedure and for 90 days after the procedure at a dose of 75 mg daily for both medications. Patients continued any prophylactic medication that they were on at the start of the trial.

Principal Findings

Of the migraine patients referred for potential study enrollment, a right-to-left shunt from a moderate-to-large PFO was documented by transthoracic echocardiography in 38%. Any type of shunt, including atrial septal defect, was present in 60%. The mean number of migraine attacks in the 30 days prior to the procedure was 4.82 in the closure group and 4.51 in the sham group. No PFO was identifiable in 7% of the closure group. Residual moderate-to-large right-to-left shunt was present in four patients at 6 months. There were more serious procedural-related adverse events in the closure group (atrial fibrillation, n = 2; pericardial tamponade, n = 2; retroperitoneal hemorrhage, n = 1; and chest pain, n = 2).
Three patients in each group reported migraine cessation (p = 1.0). Similarly, for closure versus sham, there was no difference in any of the secondary endpoints; frequency of migraine attacks per month (3.23 vs. 3.52, p = 0.14), total MIDAS headache score (17 vs. 18, p = 0.88), or headache days per 3 months (18 vs. 21, p = 0.79).
No difference in treatment effect was noted, regardless of whether a residual shunt was present at follow-up. Two patient outliers accounted for one-third of the study headache burden. When these patients were removed from analysis, there was a reduction of 2.2 headache days per month in the closure group versus 1.3 days per month in the sham group (p = 0.027).

Interpretation

This was the first randomized sham-controlled trial to study the effect of PFO closure in patients with refractory migraine. An important finding was that among migraine patients referred for analysis, some type of right-to-left shunt was documented in 60% (in 38% due to PFO). The primary outcome, cessation of migraine, occurred in three patients in each group. Secondary outcomes such as frequency of migraines and headache scores were also similar between the two groups.When the two patient outliers were excluded from analysis, a difference was noted in the reduction of headache days favoring PFO closure; however, this finding should only be hypothesis generating since it was a post-hoc analysis.
Failure to detect a difference between treatment groups may have been at least partly explained by lack of adequate power. It is unknown if a longer duration of follow-up to allow for more complete healing of the defect would have also been beneficial. Additionally, patients continued prophylactic medications throughout the trial, which may have made it more difficult for the PFO device to show benefit. Additional trials on the topic are forthcoming.

References:

Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) Trial. A Prospective, Multicenter, Double-Blind, Sham-Controlled Trial to Evaluate the Effectiveness of Patent Foramen Ovale Closure With STARFlex Septal Repair Implant to Resolve Refractory Migraine Headache. Circulation 2008;Mar 3:[Epub ahead of print].

Gmail - MedWire Cardiology News - 12 March 2008

Gmail - MedWire Cardiology News - 12 March 2008


Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html


Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html


Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html

Gmail - MedWire Cardiology News - 12 March 2008

Gmail - MedWire Cardiology News - 12 March 2008


Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html


Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html


Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html

Tuesday, March 11, 2008

What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?

Title: Association of Early Follow-Up After Acute Myocardial Infarction With Higher Rates of Medication
Date Posted: 3/10/2008
Author(s): Daugherty SL, Ho PM, Spertus JA, et al.
Citation: Arch Intern Med 2008;168:485-491.


Study Question: What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?

Methods: A total of 1,516 patients hospitalized with AMI participated in the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider versus those receiving follow-up from both provider types.

Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs. 71.3%; p = 0.001), aspirin (82.9% vs. 77.1%; p = 0.01), or statins (75.9% vs. 68.6%; p = 0.005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio [RR], 1.08; 95% confidence interval [CI], 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (RR, 1.11; 95% CI, 1.01-1.22).

Conclusions: Early outpatient follow-up and collaborative follow-up after AMI are associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.

Perspective: This prospective observational study demonstrated a modest advantage of early follow-up post-MI, but which could infer a significant clinical outcome benefit. I suspect it underestimates the value of the cardiologist assessment and opportunity for referral to cardiac rehabilitation, smoking cessation, and education. Our experience is that early follow-up by a nurse practitioner can be effective as well. Melvyn Rubenfire, M.D., F.A.C.C.

Monday, March 10, 2008

Gmail - MedWire Cardiology News - 10 March 2008

Gmail - MedWire Cardiology News - 10 March 2008

CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html

Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle
_age_has_heart_benefits.html


Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html

Sunday, March 9, 2008

Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)

Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)

Interpretation
The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.
This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.
There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.

Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.

Friday, March 7, 2008

Angiotensin II Vaccine Lowers Blood Pressure

Physician's First Watch for March 7, 2008David G. Fairchild, MD, MPH, Editor-in-Chief

A vaccine against angiotensin II lowers blood pressure, reports Lancet.

In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.

By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).

Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."

Lancet abstract (Free abstract; full text requires subscription)
Lancet comment (Subscription required

Sunday, March 2, 2008

Loud Snoring Associated With Higher Stroke And Heart Disease Risk

01 Mar 2008

If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.

You can read about this in the journal Sleep.

The authors explain that everybody snores to some extent at some period in their lives.

Estimates indicate that approximately 40% of men and 24% of women snore regularly.

Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.

The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.

The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.

They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.

The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."

"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"

Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD

SLEEP Volume 31, Issue 03, Pages 411-416

Click here to view abstract online

Saturday, March 1, 2008

Medwire - 29.02.08

Minority of CHD patients do recommended exercise
29 February 2008
Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.

Information, reassurance, and support aid post-CABG recovery
29 February 2008
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.

Persistent hyperglycemia in AMI predicts in-hospital mortality
29 February 2008
Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.