Angina.com Interview with:
Ali Shafiq, MD
Cardiovascular Fellow, Outcomes Research
Division of Cardiology
St Luke’s Mid America Heart Institute
University of Missouri, Kansas City
Angina.com: What is the background for this study? What are the main findings?
Dr. Shafiq: In order to optimally manage patients’ angina, physicians must first accurately elicit the presence and frequency of patients’ angina. While this process may seem intuitive, prior studies have demonstrated that this can be challenging in busy outpatient clinics. We found that among outpatients with stable coronary artery disease, there is substantial discordance between patient-reported and cardiologist-estimated burden of angina. Even when patients reported daily or weekly angina, a quarter of the time their cardiologists reported that they had no angina showing that cardiologists may not be able to accurately estimate their patients’ angina in a busy outpatient setting.
Angina.com Interview with:
Michal Tendera, MD, FESC, FACC
Professor of Medicine (Cardiology)
3rd Division of Cardiology
Medical University of Silesia
Medical Research: What is the background for this study? What are the main findings?
Angina.com: Ivabradine is the first-in-class specific inhibitor of the If current in the sinoatrial node. The If current inhibition results in heart rate lowering without affecting other aspects of cardiac function. Since heart rate is an important determinant of myocardial oxygen demand, its reduction may lead to symptomatic improvement in patients with stable coronary artery disease. Multiple short-term studies confirmed that ivabradine, alone or in combination with beta-blockers, increases the exercise time and decreases the number of angina attacks, as well as the interventional nitroglycerin use. The SIGNIFY trial, a randomized, double-blind, placebo-controlled study, including over 19 000 patients with stable coronary artery disease without clinical heart failure, in sinus rhythm and heart rate of 70 beats per minutes or more, showed that addition of ivabradine to standard background therapy did not improve clinical outcomes.
The SIGNIFY quality of life substudy included 4187 patients with CCS class >2 angina. The patients were assessed using the disease-specific Seattle Angina Questionnaire and a general visual analogue scale on health status.
Although treatment with ivabradne did not affect the primary outcome of change in physical limitation score at 12 months, it caused a consistent improvement in other quality of life parameters, notably those related to angina frequency and disease perception. The improvement on the angina frequency score was maintained for the entire follow-up duration (36 months).
The results of our study are remarkable for two reasons: the number of patients included in a double-blind, placebo-controlled study, and the length of follow-up.
University of Leicester-led study uses genetic approach to show link between height and disease:
• “We have shown that the association between shorter height and higher risk of coronary heart disease is a primary relationship and is not due to confounding factors such as nutrition or poor socioeconomic conditions.”- Professor Sir Nilesh Samani, BHF Professor of Cardiology at the University of Leicester.
• Coronary heart disease is the most common cause of death worldwide and is the UK’s single biggest killer.
• Nearly one in six men and one in ten women die from coronary heart disease.
• Coronary heart disease is responsible for around 73,000 deaths in the UK each year, an average of 200 people each day, or one every seven minutes.
• 2.3 million people are living with coronary heart disease in the UK – over 1.4 million men and 850,000 women.
MedicalResearch.com Interview with:
Dr Ronak Delewi
Department of Cardiology
Academic Medical Center, University of Amsterdam
Amsterdam The Netherlands
Medical Research: What are the main findings of the study?
Dr. Delewi: This study reports the long term follow-up of the randomized controlled HEBE trial. The HEBE study was a multicenter trial that randomized 200 patients with large first acute myocardial infarction to either intracoronary infusion of bone marrow mononuclear cells (BMMC), peripheral blood mononuclear cells (PBMC), or standard therapy. We did not see a beneficial effect on clinical outcomes of intracoronary delivery BMMC compared to controls, with comparable increments in the outcomes death and recurrent myocardial infarction up to 5-year follow-up. Nevertheless, we did observe that the increase in left ventricular end-diastolic volume was lower in the BMMC group.
Angina.com: What are the main findings of the study?
Dr. Andrade: The main findings of the study were as follows:
1) Approximately half of patients will experience early recurrence of atrial fibrillation (AF) within the first three months after a cryoballoon-based PVI procedure, which is comparable to that observed after radiofrequency based ablation procedures.
2) The majority (85%) of these recurrences occur within the first month, which suggests that the etiology relates to the acute inflammatory response within the atria (resulting in cellular dysfunction and enhanced arrhythmogenicity).
3) While early recurrence of AF after cryoballoon ablation is significantly correlated with later recurrence, nearly half of those with early recurrence of AF remain free of long-term recurrence suggesting a transient mechanism for the arrhythmia in a significant proportion of patients.
4) Early reablation is associated with an excellent long-term freedom from recurrent AF (97% one-year freedom from recurrent AF).