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Acute MI: No Clinical Benefit In Intracoronary Bone Marrow Cell Infusion Trial

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.

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Atrial Fibrillation: Early Recurrences after Cryoballoon Ablation

Jason G. Andrade, MD Montreal Heart Institute Montreal, Quebec CanadaAngina.com Interview with:
Jason G. Andrade, MD
Montreal Heart Institute
Montreal, Quebec Canada

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).

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CABG: Long Term Survival Benefit with On Pump Surgery

Angina.com Interview with:
Suk Jung Choo MD PhD
Department of Thoracic and Cardiovascular Surgery
Asan Medical Center
University of Ulsan College of Medicine
Seoul, South Korea

Angina.com: What are the main findings of the study?

Dr. Suk Jung Choo: The main findings consist of similar early and 1 year survival in both groups but a superior long term survival benefit in the on pump CABG group. The significantly more target vessel bypasses in the on pump CABG group indicated a greater completeness of revascularization which may have favorably affected the long term survival of these patients. This view agrees with the ROOBY trial outcomes which also reported a greater number of bypasses and a higher complete revascularization rate in the on pump group.

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Cardiac Troponin T: Age and Sex Reference Limits For Heart Attack Diagnosis

Maria Odette Gore, MD, MSCS University of Texas Southwestern Medical Center Department of Internal Medicine, Division of CardiologyAngina.com Interview with:
Maria Odette Gore, MD, MSCS
University of Texas Southwestern Medical Center
Department of Internal Medicine, Division of Cardiology

Angina.com: What are the main findings of the study?

Answer: The high sensitivity assay for cardiac troponin T (hs-cTnT) is used in many countries for the diagnosis of myocardial infarction, and it is probably just a matter of time until it is approved for clinical use in the United States. The upper reference limit or threshold for the hs-cTnT assay is by convention the 99th percentile value from a normal reference population, and at present it is 14 ng/L regardless of patient sex and age. The primary finding of our study is that this currently used threshold to diagnose MI with the hs-cTnT assay is far too low for most individuals in whom the test is preformed.  In more than 12,000 adults free from heart disease, stratified by age groups and sex, the 99th percentile values increased markedly with age and were higher in men compared with women. Middle aged and older men and older women had 99th percentile values far above 14 ng/L. This suggests that use of a “one size fits all” upper reference limit for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in older men.

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Ischemic Heart Disease Mortality Decreased Worldwide in High Income Countries

Angina.com Interview with:
Andrew E. Moran MD
Columbia University,
Division of General Medicine
Presbyterian Hospital
New York, NY

Angina.com: What are the main findings of the study?

Dr. Moran: We published two reports from the Global Burden of Disease, Injuries and Risk Factors (GBD) 2010 Study in Circulation.  The strength of this study is that disease outcome definitions were standardized across data types, countries, and time.  For many countries, there is little information available about ischemic heart disease.   The GBD study used modeling methods to improve the accuracy of estimates for those countries.

The main finding of the study was that age-adjusted ischemic heart disease mortality rates have declined substantially in the high income countries of the world since 1990, but there are some regions like South Asia and Eastern Europe where mortality increased.  Because the world’s population is aging, the absolute numbers of people dying from or living with ischemic heart disease  have increased.

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CVD Risk: Measuring Cardiorespiratory Fitness Without An Exercise Test

Dr. Enrique García Artero PhD Fac. CC de la Educación, Enfermería y Fisioterapia Edif. Departamental Humanidades y CC. Educación I (A) Universidad de Almería, España and Department of Exercise Science, Arnold School of Public Health University of South Carolina.Angina.com Interview with:
Dr. Enrique García Artero PhD
Fac. CC de la Educación, Enfermería y Fisioterapia
Edif. Departamental Humanidades y CC. Educación I (A)
Universidad de Almería, España and
Department of Exercise Science,
Arnold School of Public Health
University of South Carolina.

Angina.com What are the main findings of the study?

Dr. Artero: An individual’s cardiorespiratory fitness (CRF) level has long been established as one of the strongest predictors of morbidity and mortality risk. However, CRF is not routinely measured in the clinical and health care settings. In this study we provide algorithms to estimate CRF level without performing an exercise test, and we explore how that estimation can predict risk of all-cause and CVD mortality, as well as CVD incidence. This tool has shown a predictive capacity close to that from other well-known risk calculator models such as the Framingham score.

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Latest update: 9-10-2014 .