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Opening the arteries of those with stable coronary disease also opens the door to an improved sex life. Also this week, bariatric surgery helps remodel the heart.
PCI Patients Have Better Sex
Four out of five patients who have had percutaneous coronary intervention (PCI) report the quality of their lives is better, including more socializing, more time for hobbies, and an improved sex life, a survey found.
The survey, conducted on behalf of the Society for Cardiovascular Angiography and Interventions (SCAI) of 464 adult heart patients in the U.S., found that fewer PCI patients felt they were a burden to their family compared with heart surgery patients, and that PCI patients returned to work three times faster than heart surgery patients. Results were published on the SCAI website.
Appearing simultaneously with the survey is a SCAI expert consensus statement that outlines the case for PCI in certain patients with stable ischemic heart disease. In these patients, PCI does not reduce the incidence of MI or death, but does improve quality of life, according to the statement by James C. Blankenship and colleagues published online in Catheterization and Cardiovascular Interventions.
They said that quality of life should be considered in clinical trials and that patients with stable ischemic heart disease should be fully informed of the trade-offs involved with PCI.
More Drugs, Less Exercise in Stress Testing
Pharmacologic stress testing has overtaken exercise stress testing in the last 10 years, according to a survey of 73 nuclear laboratories, representing 202 physicians and 177 technologists.
Reasons for this shift include the increasing number of people who can't exercise, the development of better vasodilators, and reductions in SPECT radiation exposure, reported Peter Tilkemeier, MD, of The Miriam Hospital in Providence, R.I., and colleagues in the Jounral of Nuclear Cardiology.
The survey, conducted by the American Society of Nuclear Cardiology, revealed a significant shift away from dual-isotope imaging. However, researchers expressed concern that 15% of imagers still use the dual protocol, which carries a higher radiation exposure.
Another disturbing finding the researchers pointed out is that 10% of nuclear labs are not yet accredited. They missed the Jan. 1, 2012, deadline, and now cannot bill under Part B of the Medicare Physician Fee Schedule.
Also in terms of quality, only 50% of labs voluntarily use the appropriate use criteria developed by the American College of Cardiology, and 39% of respondents do not use the recommended 17-segment model for reporting.
Gender Plays Role in Favorable MI Recovery
Following reperfusion for STEMI, women tended to have smaller infarct size (both acutely and on follow-up), higher myocardial salvage, and less microvascular damage compared with men, according to a study in the European Heart Journal: Cardiovascular Imaging.
These favorably findings occurred for women despite the fact that they were older at presentation and had a higher prevalence of hypertension.
This suggests "that gender may account for the differences in the response to ischemic injury," wrote Luciano Agati, MD, of 'Sapienza' University of Rome, and colleagues.
The study, which included 283 patients (16% women), used cardiac MR to image the heart. Researchers concluded that women with acute coronary syndromes should receive fast and aggressive reperfusion therapy "in order to protect their higher amount of salvaged myocardium in the acute phase."
Surgery for Obesity Changes Heart Structure, Function
Not only does bariatric surgery improve cardiovascular risk factors, but it also remodels the heart, a systematic review found.
Pooled data from 16 studies showed significant postoperative reduction in left ventricular mass with a standardized mean difference of 0.69 at about 2 years, according to James B. Young, MD, and colleagues from the Cleveland Clinic.
The E/A ratio improved from 1.28 to 1.48, and there was a significant improvement in isovolumic relaxation time, "one of the most consistent diastolic abnormalities seen in obese individuals, from 84 ms to 72.9 ms," they reported in the journal Heart.
Regarding CV risk factors, between 26% and 36% of patients showed resolution or improvement of hypertension, diabetes, or hyperlipidemia at a mean of about 5 years, equating to a reduction in the 10-year Framingham risk score from 5.9% to 3.3%.
Eight studies showed that C-reactive protein was significantly decreased postoperatively from 9.1 mg/L to 2.5 mg/L.
"The next step should be to move from risk factors or scores to routinely collecting data on long-term (>10-year) actual cardiovascular events, cardiovascular mortality, and all-cause mortality," researchers concluded.
More Confirmation of Defective Leads
Irish researchers found that 15% of patients with Riata implantable cardioverter defibrillator (ICD) leads had insulation defects that have plagued this product and prompted its recall.
A total of 25 of the 165 patients screened at Royal Victoria Hospital in Belfast had leads whose conductors breached the insulation and became externalized, reported Vivek N. Kodoth, MD, and colleagues.
The mean duration post-implant was nearly 4 years and time since implantation was significantly associated with externalized conductors, as were the presence of a single coil lead and patient age, according to the study published online in PACE.
Researchers emphasized that "high-resolution fluoroscopic imaging in at least two orthogonal views is required to identify this abnormality."