Author Interviews, Heart Disease, JACC / 23.01.2016
Cardiac Groups Outline Appropriate Imaging For Chest Pain in ER
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Dr. Frank Rybicki[/caption]
MedicalResearch.com Interview with:
Frank J. Rybicki, MD, PhD
Professor, Chair and Chief, Department of Radiology
The University of Ottawa, Faculty of Medicine and
The Ottawa Hospital
Editor-in-Chief, 3D Printing in Medicine
Medical Research: What is the background for this document?
Dr. Rybicki: This document represents a conglomeration of the approach to appropriateness of three large medical professional groups. The American College of Radiology Appropriateness Criteria® are evidence based guidelines to assist referring physicians to order the most appropriate imaging test for a wide range of clinical scenarios. The Appropriateness Criteria are divided by organ section, and while they include emergent imaging studies, there is not a single publication to provide imaging guidance for patients who present to the emergency room with chest pain. The American College of Cardiology Appropriate Use Criteria provides evidence based data for a very large gamut of cardiovascular conditions. These guidelines include emergent cardiovascular imaging; however the Appropriate Use Criteria are divided by modality and like the ACR have not specially addressed this important, high risk patient population. The American College of Emergency Physicians, a key stakeholder group that represents referring physicians, has developed a large number of guidelines but also has not organized this group of imaging recommendations. Thus, the background of this document was a joint effort among all three societies to update, harmonize, and publish contemporary guidelines that can be readily incorporated into clinical practice but also provide standards for a large fraction of patients who come to the emergency room with chest pain who require imaging to evaluate for a life threatening diagnosis.
Medical Research: What types of chest pain conditions are covered by these guidelines?
Dr. Rybicki: Based on the background as noted above, the Writing Group for this important document included cardiologists, emergency physicians, and radiologists. Since the group was charged with describing common clinical scenarios seen in contemporary practice, there are four entry points for chest pain conditions. They are as follows:
Dr. Frank Rybicki[/caption]
MedicalResearch.com Interview with:
Frank J. Rybicki, MD, PhD
Professor, Chair and Chief, Department of Radiology
The University of Ottawa, Faculty of Medicine and
The Ottawa Hospital
Editor-in-Chief, 3D Printing in Medicine
Medical Research: What is the background for this document?
Dr. Rybicki: This document represents a conglomeration of the approach to appropriateness of three large medical professional groups. The American College of Radiology Appropriateness Criteria® are evidence based guidelines to assist referring physicians to order the most appropriate imaging test for a wide range of clinical scenarios. The Appropriateness Criteria are divided by organ section, and while they include emergent imaging studies, there is not a single publication to provide imaging guidance for patients who present to the emergency room with chest pain. The American College of Cardiology Appropriate Use Criteria provides evidence based data for a very large gamut of cardiovascular conditions. These guidelines include emergent cardiovascular imaging; however the Appropriate Use Criteria are divided by modality and like the ACR have not specially addressed this important, high risk patient population. The American College of Emergency Physicians, a key stakeholder group that represents referring physicians, has developed a large number of guidelines but also has not organized this group of imaging recommendations. Thus, the background of this document was a joint effort among all three societies to update, harmonize, and publish contemporary guidelines that can be readily incorporated into clinical practice but also provide standards for a large fraction of patients who come to the emergency room with chest pain who require imaging to evaluate for a life threatening diagnosis.
Medical Research: What types of chest pain conditions are covered by these guidelines?
Dr. Rybicki: Based on the background as noted above, the Writing Group for this important document included cardiologists, emergency physicians, and radiologists. Since the group was charged with describing common clinical scenarios seen in contemporary practice, there are four entry points for chest pain conditions. They are as follows:
- Suspected Non-ST Segment Elevation Acute Coronary Syndrome
- Suspected Pulmonary Embolism
- Suspected Acute Syndrome of the Aorta
- Patients for Whom a Leading Diagnosis is Problematic or not Possible
Dr. Yitschak Biton[/caption]
MedicalResearch.com Interview with:
Yitschak (Yitsik) Biton, MD
Postdoctoral Research Fellow
University of Rochester Medical Center
Saunders Research Building
Heart Research Follow-Up Program
Rochester, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Biton: Patients with heart failure and reduced ejection fraction have increased risk for sudden cardiac death due to ventricular arrhythmias. The causes of these arrhythmias are thought to be adverse left ventricular remodeling and scarring. Cardiac resynchronization therapy has been previously shown to reverse the adverse process of remodeling and induce reduction in cardiac chamber volumes. Relative wall thickness is a measure of the remodeling process, and it could be classified into normal, eccentric and concentric. In our study we showed that the degree relative wall thickness in patients with dilated cardiomyopathy and eccentric hypertrophy is inversely associated with the risk of ventricular arrhythmias. Furthermore we showed the CRT treated patients who had increase in relative wall thickness (became less eccentric) had lower risk for ventricular arrhythmias.
Prof. De Caterina[/caption]
Prof. Raffaele De Caterina M.D., Ph.D
University Cardiology Division G. d'Annunzio University
Medical Research: What is the background for this study? What are the main findings?
Dr. De Caterina: There is uncertainty on how to predict bleeding upon treatment with anticoagulants, because bleeding risk scores and thromboembolic risk score fare very similarly in predicting bleeding, making the net clinical benefit difficult to assess in the single patient. Here we find that a history of bleeding – even minor bleeding – has an important prognostic value on the risk of future bleeding – virtually all sorts of future bleeding, with the notable exception of intracranial hemorrhage. Some novel oral anticoagulants (NOACs), such as apixaban, studied here, reduce the risk of major bleeding, and appear to benefit independent of the bleeding history.
Dr. Ajay Dharod[/caption]
Dr. Islam Elgendy[/caption]
MedicalResearch.com Interview with:
Dr.James DiNicolantonio[/caption]
MedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. DiNicolantonio: We comprehensively reviewed the literature looking at the cardiovascular effects of saturated fat and compared them with refined sugars (sucrose and high-fructose corn syrup). Our main finding is that saturated fat per se is not necessarily unhealthy. Importantly, people eat foods, not saturated fat, and depending on what foods are consumed determines if saturated fat associates with health risk. For example, the consumption of processed meat is associated with an increased risk of cardiovascular disease, whereas dairy is not. Importantly, the replacement of saturated fat with refined sugars seems to increase the risk of myocardial infarction. Hence, reducing added sugars should be the main focus rather than reducing saturated fat, as the latter could translate to reductions in healthy whole foods that just so happen to also be high in saturated fat (but also provide other healthy fats).
MedicalResearch.com Interview with:
Tanush Gupta, MD
Chief Resident & Instructor of Medicine and
Prakash Harikrishnan, MD
Fellow in Cardiology
New York Medical College at
Westchester Medical Center
Valhalla, NY
Medical Research: What is the background for this study?
Response: Complete heart block (CHB) is a relatively frequent complication in patients hospitalized with ST-elevation myocardial infarction (STEMI). Patients who develop complete heart block in the setting of STEMI have a 3- to 5-fold increase in in-hospital mortality compared to those without CHB. However, most of the existing reports on CHB complicating STEMI are from the pre-thrombolytic and thrombolytic era in the 1980s and 1990s, before the widespread use of percutaneous coronary intervention (PCI) and advent of modern adjunctive medical therapies.
Hence, the purpose of this investigation was to examine the association of complete heart block with in-hospital outcomes in patients hospitalized with STEMI and to examine the temporal trends in the incidence and outcomes of CHB complicating STEMI using the National Inpatient Sample (NIS) databases from 2003 to 2012.
Dr. Victor Serebruany[/caption]
MedicalResearch.com Interview with:
Dr. Sunil Sharma[/caption]
MedicalResearch.com Interview with:
Sunil Sharma MD, FAASM
Associate Professor of Medicine
Director, Pulmonary Sleep Medicine
Associate Director, Jefferson Sleep Disorders Center
Thomas Jefferson University and Hospitals
Philadelphia, PA 19107
Medical Research: What is the background for this study?
Dr. Sharma: Congestive heart failure (CHF) is the most common cause of hospital admission and readmissions in United States. More health care dollars are spent on CHF than any other diagnosis. A large chunk of this cost is due to hospital admission. An estimated 50% of the CHF patients are readmitted within 6 months of discharge. The recent Protection Affordable Care Act (ACA) imposes penalties on hospitals for readmissions within first 30-days. It is therefore imperative to find ways to impact the natural history of the disease.
Sleep disordered breathing is a common disorder associated with 
Dr. Green[/caption]
MedicalResearch.com Interview with:
Ariel R. Green, M.D., M.P.H
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Implantable cardioverter-defibrillators (ICDs) are widely used to prevent sudden cardiac death in patients with systolic heart failure. Older adults with heart failure often have multiple coexisting conditions and are frail, increasing their risk of death from non-cardiac causes. Our understanding of outcomes in older patients with ICDs is limited.
Medical Research: What should clinicians and patients take away from your report?
Response: Our major finding was that more than 10% of patients currently receiving ICDs for primary prevention of sudden cardiac death (meaning that they have never had a potentially lethal arrhythmia but are at risk for one, usually due to systolic heart failure) are frail or have dementia. Patients with these geriatric conditions had substantially higher mortality within the first year after ICD implantation than those without these conditions. 
Dr. Dalane Kitzman[/caption]
MedicalResearch.com Interview with:
Dalane W. Kitzman, M.D.
Professor, Cardiology
Sticht Center on Aging
Gerontology and Geriatric Medicine
Translational Science Institute
Wake-Forest Baptist Health
Winston-Salem, NC
Medical Research: What is the background of the research?
Dr. Kitzman: Heart Failure With Preserved Ejection Fraction (HFPEF) is a relatively recently recognized disorder. It used to be thought that it was rare. However, we now realize that HFPEF is the dominant form of heart failure in America. It is also the fastest growing cardiovascular disorder. Interestingly, this disorder occurs almost exclusively among older persons, particularly women. The need is great because outcomes in persons with HFPEF (death, rehospitalization, health care costs) are worsening. This stands in contrast to most other cardiovascular disorders which are on the decline and / or are experiencing greatly improved outcomes. Remarkably, all of the large studies that have used medications in HFPEF that seemed they should be ‘sure bets’ showed no benefit for their primary outcomes. Thus, this is also the only major cardiovascular disorder where there is no proven medication treatment. That means physicians take ‘educated guesses’ in choosing treatment for this large group of patients.
The main symptom in patients with chronic HFPEF is shortness of breath and and fatigue with exertion. We showed in 2002 in JAMA that when we objectively measured this symptom with expired gas analysis (Peak VO2), this was as severely decreased in HFPEF as in patients with HFREF (severely reduced EF), the classic, well accepted form of heart failure. That and other studies helped lead to acceptance of HFPEF as a true Heart Failure disorder.
We first showed 5 years ago that 4 months of exercise training improves peak VO2 and quality of life in patients with HFPEF. In fact, exercise remains the only proven means to improve these patients’ chronic symptoms.
The goal of our study was to determine if weight loss diet also improved peak VO2 and quality of life in HFPEF patients, alone and in combination with exercise training. This was based on the under-recognized fact that over 80% of Heart Failure With Preserved Ejection Fraction patients are overweight or obese. It was already known that weight loss diet in other groups of older persons improves peak VO2 and quality of life. And small studies of 
Dr. Daniel Mulrooney[/caption]
MedicalResearch.com Interview with:
Daniel A. Mulrooney, MD, MS
Cancer Survivorship
Jude Children's Research Hospital
TN 38105-3678
Medical Research: What is the background for this study? What are the main findings?
Dr. Mulrooney: This is a cross-sectional analysis performed in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study designed to facilitate longitudinal evaluation of health outcomes among adults previously treated for childhood cancer. Following patients over the life spectrum can be challenging making it difficult to understand the long-term health effects of childhood cancer therapy. Previous studies have relied on self-report, registry, or death certificate data. Our study is novel because we clinically evaluated cancer survivors on the St. Jude campus and identified substantial, asymptomatic cardiac disease (cardiomyopathy, coronary artery disease, valvular disease, and conduction/rhythm disorders).
Dr. Mary Hawn[/caption]
MedicalResearch.com Interview with:
Dr. Mary Hawn MD MPH
Chair, Department of Surgery
Stanford School of Medicine
Stanford, California
Medical Research: What is the background for this study? What are the main findings?
Dr. Hawn: Patients with known coronary artery disease are at higher risk for adverse cardiac events in the peri-operative period. Revascularization with coronary stents does not appear to mitigate this risk and in fact, may elevate the risk if surgery is in the early post-stent period. Drug eluting stents pose a particular dilemma as these patients require 12 months of dual anti platelet therapy to prevent stent thrombosis, thus elective surgery is recommended to be delayed during this period. In contrast, bare metal stents with early epithilialization are not at the same risk for stent thrombosis with anti platelet cessation. In our retrospective cohort study, however, we observed that stent type was not a major driver of adverse events in the early post-stent period and that underlying cardiac disease and acuity of the surgery explained most of the risk. We undertook this study to determine the influence of the underlying indication for the stent procedure on surgical outcomes over time following the stent.
Dr. Renato Lopes[/caption]
MedicalResearch.com Interview with:
Renato D. Lopes MD, MHS, PhD
Duke University Medical Center
Duke Clinical Research Institute
Durham, NC 27705
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Dr. Vavalle[/caption]
John P. Vavalle, MD, MHS
Assistant Professor of Medicine
Division of Cardiology
UNC Center for Heart & Vascular Care
Medical Research: What is the background for this study? What are the main findings?
Dr. Lopes: Patients with varying degrees of underlying renal failure who presented for primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI) were studied as part of the APEX-AMI trial.
Baseline renal dysfunction portends a worse prognosis in patients undergoing PCI. However, the association between clinical outcomes and angiographic results with baseline renal function in this population of STEMI patients is not clearly defined. We report the results of a trial population with a full spectrum of underlying renal function (normal to dialysis dependent) and developed a prediction model for the development of acute kidney injury following primary percutaneous coronary intervention.
In summary, patients with worse underlying renal function had worse angiographic outcomes, higher mortality, and were less likely to be treated with evidence-based medications. The rate of acute kidney injury (AKI) after PCI appears to increase with worsening underlying renal function, except for those with Class IV chronic kidney disease where the rate of AKI was lowest. Our novel prediction model for the development of AKI found that the strongest predictors of AKI were age and presenting in Killip Class III or IV.
Prof. Kazem Rahimi[/caption]
MedicalResearch.com Interview with:
Kazem Rahimi | FRCP DM MSc FESC
Associate Professor of Cardiovascular Medicine, University of Oxford
Deputy Director, The George Institute for Global Health
James Martin Fellow in Healthcare Innovation, Oxford Martin School
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust
Medical Research: What is the background for this study? What are the main findings?
Prof. Rahimi: Although the benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established, the extent to which these effects differ by baseline blood pressure, presence of co-morbidities (such as stroke or diabetes), or drug class is less clear.
Medical Research: What should clinicians and patients take away from your report?
Prof. Rahimi: Our study has several implications for clinical practice. Our findings suggest that blood pressure lowering to levels below those recommended in current guidelines (ie, systolic
blood pressure of less than 140 mm Hg) will reduce the risk of cardiovascular disease. By showing no evidence for a threshold below which blood pressure lowering ceases to work, the findings call for blood pressure lowering based on an individual’s potential net benefit from treatment rather than treatment of the risk factor to a specific target. Furthermore, the differences we identified between classes of drugs support more targeted drug use for individuals at high risk of specific outcomes (eg, calcium channel blocker therapy for individuals at high risk of stroke or and diuretics are more eff ective for prevention of heart failure).
Overall, our findings clearly show that treating 
Dr. Leclercq[/caption]
MedicalResearch.com Interview with:
Florence Leclercq, MD, PhD
Department of Cardiology
Arnaud de Villeneuve Hospital
University hospital of Montpellier
Montpellier,France
Medical Research: What is the background for this study? What are the main findings?
Response: Patients with history of coronary artery disease (CAD) are considered as a population with high risk of further coronary events. However, frequent pre-existing ECG changes observed in these patients result in difficulty interpreting new ECG aspects in case of chest discomfort. Furthermore, anxiety frequently induced non-cardiac causes of chest pain in these patients, leading to unjustified admission to cardiology units. Moreover, levels of troponin are usually higher in patients with previous CAD compared to patients without history of angina, resulting in difficulty interpreting baseline values in this population. Conversely, copeptin may be influenced by the severity of myocardial ischemia and resulting endogenous stress, and could be a useful additional marker to exclude severe coronary stenosis in high-risk patients with recent chest pain.
This propective monocentric study evaluates the incremental value of copeptin associated with high-sensitivity cardiac T troponin (hs-cTnT) to exclude severe coronary stenosis in 96 patients with coronary artery disease (CAD) and acute chest pain.
Mean age of patients was 60 +/- 13.8 years and the mean time between chest pain onset and blood samples of copeptin was 4.2 +/-2.7 hours. According to clinical decision, coronary angiography was performed in 71 patients (73.9 %) and severe stenosis diagnosed in 14 of them (14.6%). No ischemia was detected on SPECT imaging (n=25). Among the 69 patients with a negative kinetic of hs-cTnT and a negative baseline copeptin, 5 (7.4%) had a severe stenosis (NPV 0.93; 95% CI: 0.87-0.99), 4 of them related to in-stent restenosis (NPV for exclusion of native coronary stenosis: 0.98; 95% CI: 0.93-1).
We can conclude that in patients with preexisting CAD, and once Acute Myocardial Infarction (AMI) is excluded, copeptin increases the NPV of 
Dr. Jochen Reinöhl[/caption]
MedicalResearch.com Interview with:
Dr. Jochen Reinöhl
Consultant and Head of the ISAH team (intervention for structural and congenital cardiovascular diseases)
Department of Cardiology and Angiology I (Medical Director: Prof. Dr. Christoph Bode)
University Heart Center Freiburg ∙ Bad Krozingen
Medical Research: What is the background for this study? What are the main findings?
Dr. Reinöhl: Aortic valve stenosis is a medical condition with very high short-term mortality. Previously its only treatment – therefore the gold standard – consisted of surgical valve replacement. Since 2007 transcatheter aortic-valve replacement (TAVR) can be considered alternative. Its impact on clinical practice, however, is largely unknown.
TAVR numbers rose from 144 in 2007 to 9,147 in 2013, whereas surgical aortic-valve replacement procedures only marginally decreased from 8,622 to 7,048. For both groups in-hospital mortality, as well as, the incidence of stroke, bleeding and pacemaker implantation (but not acute kidney injury) decreased.
Dr. Sherry Grace[/caption]
MedicalResearch.com Interview with:
Sherry L. Grace, PhD
Professor, York University
Senior Scientist, University Health Network
University of Toronto
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Grace: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for women world-wide. Cardiac rehabilitation (CR) is an outpatient secondary prevention program composed of structured exercise and comprehensive education and counseling.Cardiac rehabilitation participation results in lower morbidity and mortality, among other benefits. Unfortunately, women are significantly less likely to adhere to these programs than men.
While the traditional model of Cardiac rehabilitation care is a hospital-based mixed-sex program, women are the minority in such programs, and state that these programs do not meet their care preferences. Two other models of CR care have been developed: hospital-based women-only (sex-specific) and monitored home-based programs. Women’s adherence to these program models is not well known.
Cardiac Rehabilitation for her Heart Event Recovery (CR4HER) was a 3 parallel arm pragmatic randomized controlled trial (RCT) designed to compare women’s program adherence to traditional hospital-based CR with males and females attending (mixed-sex), home-based CR (bi-weekly phone calls), and women-only hospital-based CR. The primary outcome was program adherence operationalized as Cardiac rehabilitation site-reported percentage of prescribed sessions completed by phone or on-site, as reported by a staff member who was blind to study objectives. The secondary outcomes included functional capacity. It was hoped that by identifying the CR program model which resulted in the greatest adherence for women, their participation and potentially their cardiac outcomes could be optimized.
MedicalResearch: What are the main findings?
Dr. Grace: Similar to previous research, we found that women did not adhere very highly to the Cardiac rehabilitation programs. Half of the women dropped out of CR, and this occurred regardless of the type of program they went to. Some women did not even start 
Dr. Daniel Friedman[/caption]
MedicalResearch.com Interview with:
Daniel Friedman, MD
Cardiology Fellow
Duke University Hospital
Durham, North Carolina
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Friedman: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce heart failure hospitalizations, heart failure symptoms, and mortality in randomized clinical trials. However, these well-known trials either formally excluded or did not report enrollment of patients with more advanced chronic kidney disease (CKD), which we defined as a glomerular filtration rate of <45ml/minute. Since advanced CKD has been associated with an increased risk of adverse outcomes among patients with a variety of pacemakers and defibrillators, many have questioned whether the risks of CRT may outweigh the benefits in this population. Furthermore, many have hypothesized that the competing causes of morbidity and mortality among advanced CKD patients who meet criteria for CRT may mitigate clinical response and net benefit.
Our study assessed the comparative effectiveness of CRT with defibrillator (CRT-D) versus defibrillator alone in CRT eligible patients with a glomerular filtration rate of <60ml/minute (Stage III-V CKD, including those on dialysis). We demonstrated that CRT-D use was associated with a significant reduction in heart failure hospitalization or death in the overall population and across the spectrum of CKD. The lower rates of heart failure hospitalization or death was apparent in all subgroups we tested except for those without a left bundle branch block. Importantly, we also demonstrated that complication rates did not increase with increasing severity of CKD.
Dr. Nakharni[/caption]
MedicalResearch.com Interview with:
Girish N. Nadkarni, MD, MPH
Division of Nephrology, Department of Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Nadkarni: Cardiovascular disease is one of the major causes of morbidity and mortality in patients with kidney disease. Moreover, there is a lack of good quality evidence in kidney disease patients. In addition, previous studies have shown that cardiovascular trials exclude patients with kidney disease. We wanted to analyze all of the clinical trials on acute myocardial infarctions and heart failure in the last decade and see if they continued excluding patients with kidney disease. We discovered that in 371 trials including close to six hundred thousand patients, the majority (57%) excluded patients with kidney disease. A large proportion of the trials excluded patients for non-specific reasons, rather than a prespecified threshold of kidney function and did not report kidney function at baseline. Finally, in trials that did include kidney patients and reported outcomes by 
Dr. Al-Kindi[/caption]
MedicalResearch.com Interview with:
Sadeer G Al-Kindi, MD
Fellow, Harrington Heart and Vascular Institute
Onco-Cardiology Program, Advanced Heart Failure and Transplant Center, Harrington Heart and Vascular Institute,
University Hospitals Case Medical Center
Cleveland, OH
Medical Research: What is the background for this study?
Dr. Al-Kindi: Cardiovascular disease and cancer are the most common causes of death in the United States. They often have the same risk factors (for example, smoking, advancing age, obesity). Many cancers are treated with drugs that can have detrimental effect on the heart thus limiting their use. Some studies have suggested that cardiovascular diseases can worsen outcomes in patients with cancer. The emergence of onco-cardiology programs led to multidisciplinary care of patients with cancer and heart disease. Given this tight relationship between cancers and cardiovascular disease, we hypothesized that heart disease and its risk factors are very common in patients diagnosed with cancer.
Medical Research: What are the main findings?
Dr. Al-Kindi: Using a very large clinical database of 1/8th of the US population, we identified patients with most common cancers that are treated with cardiotoxic medications and identified the prevalence of cardiovascular diseases. Overall, prevalence was 33% for hematologic malignancies (leukemia and lymphoma), 43% for lung cancers, 17% for breast cancers, 26% for colon cancers, 35% for renal cancers, and 26% for head and neck cancers. Peripheral artery disease, coronary artery disease and cerebrovascular diseases were the most common, followed by heart failure, and carotid artery disease. Despite the high prevalence, only about a half of these patients were on the cardiovascular medicines and half were referred to cardiologists.
Dr. Kaltman[/caption]
MedicalResearch.com Interview with:
Jonathan Kaltman, MD
Chief, Heart Development and Structural Diseases Branch
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute
Medical Research: What are the main findings?
Dr. Kaltman: Congenital heart disease (CHD) is the most common birth defect but the cause for most defects is unknown. Surgery and clinical care of patients with congenital heart disease has improved survival but now we are learning that many patients have neurodevelopmental abnormalities, including learning disability and attention/behavioral issues.
Medical Research: What are the main findings?
Dr. Daniels[/caption]
MedicalResearch.com Interview with:
Lori Daniels, MD, MAS, FACC
Professor of Medicine
Director, Coronary Care Unit
UCSD Division of Cardiology
Sulpizio Cardiovascular Center
La Jolla, CA
Medical Research: What is the background for this study?
Dr. Daniels: A large number of individuals who are at risk for developing cardiovascular disease (CVD) may not be identified as “at risk” by traditional screening methods. Blood-based biomarkers provide a possible way, in conjunction with traditional risk factor screening, to assess risk in individuals. Two such biomarkers which are gaining widespread attention are NT-proBNP and cardiac troponin T (TnT). NT-proBNP is secreted by cardiac muscle cells in response to stretch, while TnT is consider a marker of cardiac cellular damage. Previous studies have shown that each of these markers is associated with long-term risk of cardiovascular outcomes in the general population. Race and ethnicity have been shown to affect the levels of these markers, and whether these markers are equally predictive of future cardiovascular risk in various ethnic groups has not been well studied.
The Multi-Ethnic Study of Atherosclerosis (MESA) is an NIH-funded, multicenter, prospective, population-based study of white, black, Hispanic, and Chinese individuals without clinical CVD at baseline. Participants had blood drawn at a baseline study visit in 2000-2002, and again several years later, in 2004-2005. They have been followed for the development of CVD since then.
The purpose of this study was to learn whether NT-proBNP (single and serial measures) and TnT are predictive of incident cardiovascular disease in a diverse cohort of 5592 participants from the MESA. We also wanted to learn whether the addition of these biomarkers to established CVD risk prediction scores, including the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Pooled Cohort Risk Equation and the Framingham Risk Score, could improve performance of the risk score.