Heart News and Notes

Metabolic syndrome, according to Adult Treatment Panel III criteria, is having any three out of five risk factor: high blood pressure, central obesity, high blood sugar, low HDL and high triglycerides.

In an analysis published last month in Circulation, tracking over 3000 people, the prevalence of metabolic syndrome increased by 70 percent over a 12 year period.

But heart disease risk and mortality was significantly higher only for those whose three risk factors were either high blood pressure, central obesity, and high blood sugar, or high blood pressure, low HDL and high triglycerides. No other combination was associated with significantly higher risk.

Doctors at Castle Hill Hospital, Hull, UK, wondered why patients in heart failure studies fared so much better than heart failure patients in their practice. So they asked all the heart failure patients who came into the clinic whether they would be willing to take part in a clinical research project, and analyzed the results.

Out of 19 variables - such as age, severity of heart dysfunction, drug use or other illnesses - the best predictor of survival turned out to be willingness to take part in a clinical trial - even if they didn’t actually enroll in a trial! Could it have something to do with “positive attitude”?

Men who drink two drinks a day or more, even in excess of nine drinks a day, all have about half the heart disease risk of men who never drank, according to a large study in Spain. No significant association was found for women, probably because the women had so few coronary events.

The study was observational, not randomized, and it looked only for coronary heart events, not all-cause mortality (which increases with increasing alcohol use).

Previous studies suggest that two drinks a day (one for women) is associated with better survival than drinking either more or less. Alcohol in any amount protects the heart, but too much can cause other problems.

We’ve heard in some of our meetings about biventricular pacing for heart failure patients - a pacemaker pulsing both sides of the heart at the same time. In patients with a slow heartbeat, but no heart failure, a a pacemaker often sends pulses only to the right atrium or the right ventricle.

Evidence is accumulating that in some patients, pacing only the right ventricle causes asynchrony, left ventricle dysfunction, and heart failure. Newly implanted pacemakers should be biventricular; patients with right ventricular pacing should be switched to biventricular pacing if they need it.

Cooling cardiac arrest patients reduces the risk of brain damage after the patient is resuscitated, and the sooner cooling is begun the better. A new portable device called Rhino-Chill introduces a volatile coolant into the nose through nasal prongs like those used for oxygen, and the brain is cooled via blood vessels close to the nasal passages. A small trial called PRINCE (Pre-Resuscitation Intra-Nasal Cooling Effectiveness) tested the device in European countries where it has been approved for marketing.

In the trial, 83 patients were randomly assigned to test the device and 99 received standard care. Survival to hospital discharge was 47 percent in the test group and 31 percent in the control group. Survival without neurological damage was 37 percent in the test group and 21 percent in the control group. The difference is not statistically significant, but significant results were seen when cooling began within 10 minutes of cardiac arrest.

The device is expected to be available in Europe early next year, and the manufacturer plans to seek FDA approval here.

If you’ve ever had heart surgery for bypass or valve work you might remember the lasting chest discomfort that made many ordinary tasks (including breathing) difficult. Surgeons get access to the heart by splitting the sternum (a.k.a. breastbone) so they can pull the rib cage open, and it takes time for the sternum to heal after it’s wired together.

Kryptonite^TM bone cement, made in Connecticut, is already approved for bone repair. Doctors in Calgary, AB, Canada, tried it to repair the sternum of a patient whose sternum opened after the wires broke, and it was a resounding success.

They found in a pilot study that using it routinely after heart surgery enables patients to resume normal activities in days instead of months. Their next step will be STICK (STernal Innovative Closure with Kryptonite), a worldwide trial on over 500 patients.

Few arteries are close enough to the skin to get a catheter into them for coronary catheterization, angioplasty or stenting. The usual access site is the femoral artery at the groin.

Radial access - inserting the catheter in the radial artery at the wrist - is used in about 50 percent of procedures in some European and Asian countries, but only in about 5 percent in the U.S.

The RAPTOR trial, presented last month at an American Heart Association conference, was designed to see whether experienced cardiologists can switch safely from femoral to radial access. It found that radial access takes less time because, although puncturing the artery can take longer, closing it is easier. It’s also easier on the patient and there are fewer bleeding complications.