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Cardio NewsWire - archive

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The Cardio NewsWire site hosts highlighted news stories from the field of cardiology. This page holds an archive of previous stories published within the last 90 days, after this time stories are removed from the site.

Anger and myocardial infarction
Passive smoking and arterial damage
Non-invasive identification of plaques
17th International Congress on Advances in Cardiac Ultrasound
50th Anniversary of Angioplasty
ICHB 2014 is just around the corner
Cardiologists urged to reduce inappropriate radiation exposure
FDA approves new DES system
More people are smoking
Heart disease and dementia
AHA Late-Breaking Clinical Trials 2013: The SITAGRAMI Trial
ESC Congress 2014
New EHJ Board members 2014
Warfarin increases stroke risk
ESC News December
ESC Grants
AHA Late-Breaking Clinical Trial: The RADAR-AF Trial at AHA

OUTBURSTS OF ANGER LINKED TO GREATER RISK OF MI AND STROKES

Outbursts of anger may trigger myocardial infarction, strokes and other cardiovascular problems in the two hours immediately following an anger spell, according to the first study to systematically evaluate previous research into the link between extreme emotions and all cardiovascular outcomes.

The study – a systematic review and meta-analysis – published in the European Heart Journal [1], found that in the two hours immediately after an angry outburst, a person’s risk of MI or acute coronary syndrome (ACS) increased nearly five-fold (4.74%), the risk of stroke increased more than three-fold (3.62%), and the risk of ventricular arrhythmia also increased compared to other times when they were not angry.

The absolute risk increased if people had existing cardiac risk factors and the more frequently they were angry.

The researchers say their results do not indicate that anger causes the cardiovascular problems, only that they are associated with them. However, they say the results are fairly consistent across the studies even though they were conducted over more than 18 years in different countries and groups of people.

The author’s concluded: “Given the lessons we have learned from trying to treat depression after MI, treating anger in isolation is unlikely to have an impact. Instead, a broader and more comprehensive approach to treating acute and chronic mental stress and its associated psychological stressors, is likely to be needed to heal a hostile heart.”

[1] “Outbursts of anger as a trigger of acute cardiovascular events: a systematic review and meta-analysis”, by Elizabeth Mostofsky, Elizabeth Anne Penner, and Murray A. Mittleman. European Heart Journal. doi:10.1093/eurheartj/ehu033

PASSIVE SMOKING AND ARTERIAL DAMAGE

Passive smoking causes irreversible damage to children’s arteries

Exposure to passive smoking in childhood causes irreversible damage to the structure of children’s arteries, according to a study just published online in the European Heart Journal [1].

The researchers from Australia, Finland and Tasmania say that exposure to both parents smoking in childhood adds an extra 3.3 years to the age of blood vessels when the children reach adulthood. Interestingly, the study did not show an effect if only one parent smoked.

The study is the first to follow children through to adulthood in order to examine the association between exposure to parental smoking and increased carotid intima-media thickness (IMT) in adulthood. It adds further strength to the arguments for banning smoking in areas where children may be present, such as cars. The results took account of other factors that could explain the association such as education, the children’s smoking habits, physical activity, body mass index, alcohol consumption and biological cardiovascular risk factors such as blood pressure and cholesterol levels in adulthood.

In an accompanying editorial, David Celermajer, Scandrett Professor of Cardiology at the University of Sydney, Australia, and Dr Edmund Lau, clinical associate lecturer at the University of Sydney, call on legislators worldwide to do more to protect children from the harmful effects of tobacco smoke. “Banning smoking in cars where young people are present targets an environment where exposure is high. Such legislation already exists in Australia, Canada, and USA”.

[1] “Exposure to parental smoking in childhood or adolescence is associated with increased carotid intima-media thickness in young adults: evidence from the Cardiovascular Risk in Young Finns study and the Childhood Determinants of Adult Health Study”, by Seana Gall et al. European Heart Journal. doi:10.1093/eurheartj/ehu049

NON-INVASIVE IDENTIFICATION OF PLAQUES

First non-invasive imaging method to identify ruptured and high-risk plaques

Researchers in the UK have described the first non-invasive imaging method to identify and localise ruptured and high-risk coronary atherosclerotic plaques. They found that 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) identifies culprit ruptured plaques in patients with myocardial infarction and symptomatic carotid disease. It also identifies coronary plaques with high risk features in patients with stable coronary artery disease.

This prospective study included 40 patients with myocardial infarction, 40 patients with stable angina pectoris undergoing elective invasive coronary angiography and 9 patients undergoing carotid endarterectomy for symptomatic carotid artery disease.

The researchers used combined PET and computed tomography (CT) to identify ruptured and high risk atherosclerotic plaques using the radioactive tracers’ 18F-NaF and 18F-fluorodeoxyglucose (18F-FDG).

Patients with myocardial infarction and stable angina underwent 18F-NaF and 18F-FDG PET-CT and CT coronary angiography. 18F-NaF uptake was compared with histology in the carotid endarterectomy specimens and with intravascular ultrasound in patients with stable angina.

The researchers found that 18F-NaF localised the culprit ruptured plaque in 37 MI patients (93%). There was marked 18F-NaF uptake at the site of all carotid plaque ruptures and this was associated with histological evidence of active calcification, macrophage infiltration, apoptosis and necrosis. In patients with stable angina, 45% had plaques with focal 18F-NaF uptake that were associated with more high risk features on intravascular ultrasound than those without uptake.

The researchers say prospective studies are now needed to find out whether increased coronary 18F-NaF activity translates into adverse events. If yes, the treatment of coronary artery disease may be fundamentally altered to a focus on plaque metabolism and inflammation. Patients with single or multiple high risk or silently rupture plaques could be identified and treated to prevent future cardiovascular events.

The full paper in The Lancet is available here.

CONGRESS ON ADVANCES IN CARDIAC ULTRASOUND

device

One of the oldest courses on clinical echocardiography has ended in Davos, Switzerland.

New echocardiographic techniques and their applications on the use of 3D and even 4D imaging were presented. The latest developments on 3D ECHO in the evaluation of heart valve disease, the use of 3D ECHO during cardiac catheterization interventions and the use of 2D & 3D ECHO during percutaneous closure of ASDs, patent foramen ovale and left atrial appendage were presented.

The use of strain and deformation imaging using 2D and 3D approaches to assess left ventricular function was reviewed. In the future using LV global strain may replace LV ejection fraction in assessing systolic function.

Dr R. Erbel (Essen, Germany) presented a keynote lecture on the Evaluation of Aortic Diseases and course co-director Dr Petros Nihoyannopoulos concluded with a keynote lecture on Pregnancy and The Heart.

Course directors
Course directors Jeroen J Bax (L) and Petros Nihoyannopoulos (R)

The entire 4 days of the course were transmitted live over the internet by Live Media, http://www.livemedia.com/davos2014

50TH ANNIVERSARY OF ANGIOPLASTY

Charles Theodore Dotter

Last month, January 2014, angioplasty celebrated its 50th anniversary. On 16 January 1964, Dr Charles Theodore Dotter an interventional radiologist at the University of Oregon Hospital, Portland, Oregon, USA, performed the first-ever angioplasty.

He performed the world’s first percutaneous transluminal angioplasty, dilating a highly stenotic superficial femoral artery successfully in an 82 year old lady who had refused amputation for foot gangrene and ischaemic pain. Dr Dotter used incremental increasing diameter coaxial Teflon catheters introduced through a percutaneous common femoral needle arteriotomy. The artery remained open until her death 2 and a half years later from pneumonia.

THE 2ND INTERNATIONAL CONFERENCE ON HEART AND BRAIN

ICHB2014

Bringing the heart and brain together, the ICHB 2104 takes place 27 February to 1 March in Paris, France.

A Keynote lecture by Prof. Louis Caplan, USA on Screening scores – CHADS2 and ABCD2 will be on Thursday, February 27th.

Additional plenary sessions scheduled for the same day include: 13:00-14:30 Atrial Fibrillation 16:00-17:30 Cognition & the Heart

On Friday 28 February a Keynote lecture by Prof. Gabriel Steg, France will be on Revascularization in Stable Atherosclerosis at,

12:00-12.30 The heart: from COURAGE to FAME-2

Also on Friday is a plenary session Stress, The Brain and The Heart

Of interest to the cardiologist on the final day may be the plenary session Vascular Neurology for the Cardiologist: the Device Era in Vascular Neurology.

ICHB 2014 has been accredited by the European Board for Accreditation in Cardiology (EBAC) for up to 12 CME/CPD credits.

CARDIOLOGISTS URGED TO REDUCE RADIATION EXPOSURE

Cardiologists urged to reduce inappropriate radiation exposure

Cardiologists are being urged to reduce patient radiation exposure in an ESC position paper which outlines doses and risks of common cardiology examinations for the first time. The paper was published 9 January 2014 in the European Heart Journal: http://eurheartj.oxfordjournals.org/content/early/2014/01/06/eurheartj.eht394

Picano
Lead author, Dr Eugenio Picano, FESC, said: “Cardiologists today, are the true contemporary radiologists. Cardiology accounts for 40% of patient radiology exposure and equals more than 50 chest X-rays per person per year.”

The paper lists doses and risks of the most common cardiology examinations for the first time. CT, PCI, cardiac electrophysiology and nuclear cardiology deliver a dose equivalent to 750 chest X-rays (with wide variation from 100 to 2,000 chest X-rays) per procedure.

PCI for dilation of coronary artery stenosis totals almost 1 million procedures per year in Europe. The additional lifetime risk of fatal and non-fatal cancer for one PCI ranges from 1 in 1000, to 1 in 100 for a healthy 50 year old man. Risks are 1.38 times higher in women and 4 times higher in children.

Dr Picano added, “Unfortunately, radiation risks are not widely known to all cardiologists and patients. This creates a potential for unwanted damage that will appear as cancers, decades down the line. We need the entire cardiology community to be proactive in minimising the radiological friendly fire in our imaging labs.”

Lancelloti
Professor Patrizio Lancellotti, FESC, president of the European Association of Cardiovascular Imaging (EACVI) of the ESC, said: “The radiation issue was first brought to the attention of the international cardiology community by European cardiologists and now it is right and fitting that the ESC delivers this paper.”

FDA APPROVES NEW DRUG ELUTING STENT SYSTEM

Promus Stent System
Promus-Premier Stent System
Promus Stent System
Promus-Premier Stent

In November 2013 the US Food and Drug Administration (FDA) approved the Promus PREMIER Everolimus-Eluting Platinum Chromium Coronary Stent System. The stent system features the only customized platinum chromium stent architecture of its kind in the Everolimus drug and PVDF-HFP polymer combination stent coating.

It is claimed to have low recoil, exceptional radial strength and fracture resistance, while improving axial strength and deliverability. Its visibility is enhanced by the platinum chromium alloy which has more than twice the density of iron or cobalt.

A new low profile delivery system has a PTFE coating to reduce friction, a double-segment inner lumen for flexibility, a dual-layer PEBAX balloon and a shorter red tip.

The Promus PREMIER was awarded CE Mark approval in February 2013 and is available in 94 sizes, ranging in diameter from 2.25 mm to 4.00 mm and lengths of 8 mm to 38 mm on both Monorail and Over-the-Wire catheter platforms, to accommodate unique and challenging diseased vasculature.

CARDIOLOGISTS URGED TO REDUCE RADIATION EXPOSURE

Cigarette
The global prevalence of smoking has decreased but the number of smokers has increased due to population growth according to a new study.

Researchers from the Institute of Health Metrics at the University of Washington examined smoking habits in 187 countries during 1980 to 2012. Overall, age standardised smoking prevalence decreased by 42% in women and 25% in men. Smoking was reduced by more than half in Norway, Canada, Iceland and Mexico. However, because of population growth the number of daily smokers increased by 41% for men and 7% for women.

In 2012, men had a higher rate of smoking than women in all countries except Sweden. More than 50% of men smoked every day in a number of countries including Russia, Indonesia and Armenia. The rate of smoking in women was more than 25% in Austria, Chile and France and greater than 30% in Greece.

That same year, rates of smoking for men were highest in Timor-Leste (61.1%) and lowest in Antigua and Barbuda (5%). For women, the greatest rate of smoking in 2012 was in Greece (34.7%) while the lowest was in Eritrea (0.6%). In 75 countries, smokers consumed an average of more than 20 cigarettes per day in 2012.

The researchers used a wide range of data sources to calculate the estimates, including in-country surveys, government statistics and World Health Organization data. Previous estimates have tended to use fewer sources of information.

The study is available at http://jama.jamanetwork.com/article.aspx?articleid=1812960

STUDY LINKS CVD WITH DEMENTIA

Cardiovascular disease (CVD) has been linked with cognitive decline and dementia in a prospective study of nearly 6,500 women aged 65-79 years. CVD increased the risk of cognitive decline by 29%. Risk doubled in women who had a myocardial infarction compared with those who had not. There was no association with heart failure or atrial fibrillation.

Risk of cognitive decline was increased with coronary bypass surgery (hazard ratio [HR] 2.63), carotid endarterectomy (HR 3.03), and peripheral vascular disease (HR 1.82). Hypertension and diabetes increased risk in women without CVD but not in women with CVD. Adiposity (body mass index >30kg/m2) had no effect. The full article is available here: http://jaha.ahajournals.org/content/2/6/e000369.long

THE SITAGRAMI TRIAL AT AHA 2013

Franz
Wolfgang M. Franz presented the SITAGRAMI Trial

The Safety and efficacy of SITAgliptin plus GRanulocyte-colony-stimulating factor in patients suffering from Acute Myocardial Infarction (SITAGRAMI) Trial was a phase III, multi-centre, randomized, double blind, placebo controlled study in patients with acute ST-elevation myocardial infarction (STEMI). The trial tested the hypothesis that treatment with granulocyte-colony-stimulating factor (G-CSF) based stem cell mobilization in combination with the DPP-IV inhibitor sitagliptin 6 months after MI would lead to an absolute treatment effect of 3.5% on left ventricular ejection fraction.

The primary efficacy endpoint combined global left and right ventricular ejection fraction change from baseline to 6 months follow-up using magnetic resonance imaging. A total of 174 patients were randomized to placebo or G-CSF (10µg/kg/d) over a period of 5 days together with an oral dose of 100mg sitagliptin daily for 4 weeks. The researchers found that dual stem cell therapy with G-CSF and sigagliptin after successfully revascularized acute MI was safe but failed to show a beneficial effect on cardiac function. In an unplanned subgroup analysis, female patients showed a significant increase in right ventricular ejection fraction after treatment compared to placebo which the investigators could not explain from a clinical point of view.

ESC CONGRESS 2014 REGISTRATION NOW OPEN

ESC 2014
Barcelona 30 August - 3 September 2014

The ESC Congress is the world’s largest and most influential cardiovascular event with over 500 expert sessions and 10,000 abstracts contributing to global awareness of the latest clinical trials and breakthrough discoveries.

Barcelona is preparing for the arrival of more than 30,000 participants for next year’s ESC Congress. As the world’s premier meeting on the science, management and prevention of cardiovascular disease, it draws professionals with an interest in cardiology from more than 150 countries.

There will be 600 journalists from 46 countries who will join cardiologists, cardiovascular surgeons, nurses, primary care physicians, scientists, technicians, medical students, healthcare industry leaders and regulators to catch up on the latest news in cardiology. Eleven press conferences on specific topics and breaking clinical trials will take place at the Fira Gran Via.

The 2014 Congress Spotlight is “Innovation and the Heart”. With CVD still being the biggest killer in Europe - over 4 million deaths in Europe annually - and with resources dedicated to innovation in cardiology diminishing, a resurgence in cardiovascular R&D is urgently needed to curb a new epidemic of cardiovascular diseases, according to leading cardiologists and industry representatives.

Registration at: http://www.escardio.org/congresses/esc-2014/registration/Pages/press-registration.aspx

NEW EHJ INTERNATIONAL BOARD MEMBERS 2014

The EHJ Editorial Board have appointed the following new International Editorial Board Members beginning January 2014. They are a welcome addition to the Board.

Lino Manuel Martins Gonçalves
Lino Manuel Martins Gonçalves, Associate Professor of Cardiology at the University of Coimbra Medical School, Portugal. He is an invasive cardiologist involved in research, responsible for cardiology teaching at a busy medical school and acts as a reviewer for a long list of journals. His main research interests are coronary artery disease, interventional cardiology, angiogenesis and stem cells. Recently he led the taskforce responsible for developing the ESC online educational platform.


Adelino Leite-Moreira
Adelino Leite-Moreira, Professor and Head, Department of Physiology and Cardiothoracic Surgery Faculty of Medicine, University of Porto, Portugal. His areas of particular interest are adult cardiac surgery and acquired cardiovascular diseases with expertise in total arterial off-pump CABG surgery, surgery of the aortic root and reconstructive mitral valve and aortic valve surgery. His research interests also include right ventricular function and pulmonary hypertension.

Viacheslav Mareev
Viacheslav Mareev, Consultant Cardiologist & Professor of Cardiovascular Medicine, in a medical scientific educational centre of M.V. Lomonosov Moscow State University, Russia. His scientific interests are: heart failure, myocardial diseases and cardiovascular risk factors. He is also member of the editorial board of Kardiologia Journal, the Russian Cardiology Journal and an Editorial Board member of JACC Heart Failure.


Seung-Jung Park
Seung-Jung Park, Professor of Medicine, University of Ulsan College of Medicine, Chairman, Heart Institute of Asan Medical Center, Seoul, Korea.His areas of expertise are in: Left main PCI, coronary imaging - FFR/IVUS, complex PCI (long lesions, bifurcation, and tandem lesion PCI functional approach), DES and adjunctive pharmacology.



Evgeny Shlyakhto
Evgeny Shlyakhto, Professor of Medicine, is an internist and cardiologist, the Chief Cardiologist of St. Petersburg and the North-West Region of Russia and a Member of the Russian Academy of Medical Science. Director of the National Almazov Research Medical Centre and President, Russian Society of Cardiology, Editor-in-Chief of the Russian Journal of Cardiology and Co-Editor-in-Chief of Arrhythmology Bulletin.

WARFARIN INCREASES RISK OF STROKE IN AF

Patients with atrial fibrillation (AF) have nearly double the risk of suffering a stroke in the first 30 days after starting warfarin compared to non-users, according to a study of over 70,000 patients.

The study, published in the European Heart Journal [1], found that the risk was particularly high in the first week after patients started to take the drug. In contrast, once the first 30 days had elapsed, the risk of a stroke was halved.

Randomised controlled trials of other anti-clotting drugs have suggested that there might be an increased risk of stroke at the point when patients move from the trial drugs to warfarin. In addition, it has already been established that there is a possibility that warfarin leads temporarily to a hypercoagulable state. This is thought to be due to the different effects of warfarin on the production of certain coagulation factors that are dependent on Vitamin K.

Dr Laurent Azoulay, Assistant Professor in the Department of Oncology at McGill University (Montreal, Canada) and Project Leader at the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital in Montreal, led the research. “There is no question that warfarin is highly effective in preventing strokes in patients with AF. Thus, our finding that the initiation of warfarin may be associated with an increased risk of stroke should not deter physicians and patients from using this drug, since this likely affects a small number of patients. Future studies should confirm our results, and identify the small subset of patients who may be at risk. However, the results of our study suggest that physicians should be vigilant when initiating warfarin, particularly in the first week of use,” he said.

“To our knowledge, this is the first population-based study to investigate whether the initiation of warfarin is associated with an increased risk of ischaemic stroke.”

The researchers hope to repeat the study using databases from other countries and settings.

[1] “Initiation of warfarin in patients with atrial fibrillation: early effects on ischaemic strokes”, by Laurent Azoulay, Sophie Dell’Anielllo, Teresa A. Simon, Christel Renoux, and Samy Suissa. European Heart Journal. doi:10.1093/eurheartj/eht499

ESC NEWS DECEMBER

ESC News
The ESC continued its globe-trotting in November and December, including collaborative programmes with the Mexican Society of Cardiology at its annual congress in Leon (November) and the Annual Conference of the Cardiological Society of India in Bangalore (5 - 8 December).

ESC News
Cardiovascular risk factors were a key theme at the congress in Mexico, as obesity continues to be a major challenge with calls for all 18 year-old Mexicans to be routinely screened. In India Hypertension was a critical discussion point, as high blood pressure is rocketing with rural-to-urban migrants at especially high risk.

ESC News
Closer to home, EuroEcho-Imaging, the annual congress of the ESC's European Association of Cardiovascular Imaging kicked off in Istanbul 9 December! Be sure to access all the scientific resources as they're published, including the new Valvular Box - all you need to know on valvular heart disease in one place. You can also begin preparing for ESC Congress 2014 in Barcelona - registration and abstract submission are now open, along with hotel booking!

APPROACHING DEADLINES FOR ESC GRANTS

Nurses and allied professionals: Grants to advance your career

ESC Grants
Apply for a post-doctoral mentorship award in cardiovascular care from the Council on Cardiovascular Nursing and Allied Professions. Read how this award can help you and how to apply here. Deadline for applications: 4 January 2014

Young basic researcher: 25,000 Euro Fellowship - few days left to apply!

ESC Grants
The ESC Council on Basic Cardiovascular Science is offering a fellowship of 25,000 Euros for a young basic researcher to spend one year in a European laboratory of their choice. See here for conditions and how to apply. Deadline for applications: 17 December 2013

Discover more opportunities to further you career with ESC grants here. Be sure to leave yourself time to apply!

THE RADAR-AF TRIAL AT AHA

Presented by Dr Felipe Atienza

Empiric circumferential pulmonary vein isolation (CPVI) is the therapy of choice for drug-refractory atrial fibrillation (AF). The multi-centre randomized RADAR-AF clinical trial was designed to compare the efficacy and safety of high frequency source ablation (HFSA) in AF as compared to CPVI. In a noninferiority study, 115 patients with paroxysmal AF were randomly assigned to receive CPVI or HFSA. In a superiority study, 117 patients with persistent AF were randomly assigned to receive CPVI or CPVI plus HFSA. In patients with paroxysmal AF, HFSA was noninferior to CPVI for the endpoint of freedom from AF at 12 months (HFSA 82% vs. CPVI 79%; P=0.008), with patients receiving HFSA having a reduced risk for adverse events compared with patients receiving CPVI (P=0.028). In patients with persistent AF, there was no difference between the groups in the freedom from AF at 6 or 12 month outcomes, but adverse events tended to occur more frequently in the CPVI plus HFSA group (24% vs. 10%; P=0.05). These results demonstrate that a more limited ablation strategy directed to selectively eliminate AF maintaining sources is equally effective and safer than the empiric CPVI ablation strategy in patients with paroxysmal AF.

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