While 1-year survival rates after cardiac transplantation are now of the order of 90%, approximately 30-40% of recipients suffer an episode of acute cellular rejection during their first year, and then at a reduced rate thereafter. Endomyocardial biopsy remains the standard method of monitoring for rejection in recipients of a cardiac transplant but is uncomfortable […]
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Allopurinol anti-ischaemic in stable angina
Allopurinol is a xanthine oxidase inhbitor which has previously been shown to reduce myocardial oxygen consumption in patients with heart failure. As such, as the authors of this paper decided to investigate the potential benefit of high-dose allopurinol in patients with chronic stable angina. […]
CACS improves cardiovascular risk prediction
Coronary Artery Calcium Scoring (CACS) can be used to predict the likelihood of future cardiovascular events. However, whether this provides extra information on top of traditional cardiovascular risk factors remains unclear. In this study 6814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent CACS and were then followed up for five year. None of […]
Stringent AF rate control fails to show benefit.
Guidelines for the treatment of atrial fibrillation (AF) suggest that, where rate control is the preferred management stratey, a resting heart rate of less than 80 bpm and an exercise heart rate of less than 110 bpm should be targeted. These values are based on the belief that lower heart rates will result in fewer […]
Triglyceride association with coronary disease strengthened
It is uncertain whether conditions characterized by increased circulating triglyceride concentrations are causal in coronary heart disease. Although epidemiological associations have suggested a positive correlation between triglyceride levels and coronary risk, these associations disappear after controlling for HDL and LDL cholesterol. […]
Success of Subcutaneous Defibrillator
Although Implantable Cardioverter-Defibrillators (ICDs) are an established treatment for the prevention of death from ventricular arrhythmia, they require transvenous lead implantation and thus their insertion is prone to complications. If cardiac pacing is not also required, then potentially transvenous electrodes can be avoided altogether. The authors report the results of a novel subcutaneous ICD system […]
Improved Treatments Lead to Improved CHD Mortality
Although rates of coronary heart disease (CHD) mortality have declined substantially over the last three decades, the exact reasons for this are not yet clear. Identifying the factors associated with this improvement is vital for setting future healthcare policy. Diet, lifestyle, risk factors and treatment uptake are all important, but these change rapidly and have […]
Public Defibrillators Improve Outcomes
Sudden death from cardiac arrest remains a major public health problem with generally dismal outcomes. Although early defibrillation plays a key role, it is difficult to further reduce the time from a patient’s collapse to defibrillation by emergency medical personnel, and so recent efforts have turned to increasing access to automatic external defibrillators (AEDs) in […]
BP on ICU admission for chest pain inversely correlated to mortality
Although mortality and morbidity rates from acute coronary syndromes have been declining considerably, a high risk for death remains after discharge from the intensive care unit (ICU). In this study the authors studied long-term mortality in relation to supine blood pressure in patients admitted to the medical intensive care unit for acute chest pain. The […]
Systolic blood pressure variability is strong predictor of stroke
The mechanisms by which raised blood pressure causes stroke and other vascular events are poorly understood. Although substantial variability in clinical blood pressure is often noted, episodic hypertension tends not to be treated. The prognostic value of visit-to-visit variability and episodic hypertension in the same setting has not been established. Therefore in this study the risk […]