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Researchers are taking a second look at the accuracy of treadmill exercise testing for women over 65. Also this week, the birth of a subspecialty for adults with congenital heart disease and leg artery stenting.
ECG Treadmill Test Good for Older Women
Exercise treadmill tests can accurately predict if women over 65 have coronary artery disease (CAD), according to a study in the December issue of American Journal of Cardiology.
In similar studies in the past, the inclusion of younger women -- who have less risk of CAD -- have skewed the accuracy of ECG treadmill tests for women in general. For example, the positive predictive power of ECG treadmill for women between ages 35 to 50 was 36%, compared with 68% for those over 65, according to Jeffrey M. Levisman, MD, of the University of California at Davis, and colleagues.
In addition, researchers found that several specific exercise responses (ST-segment depression >2 mm and delayed ST-segment recovery >3.0 minutes) further separated true from false positives across all age groups, but further increased the positive predictive power for those over 65 to approximately 80%.
The study also supports the guidelines of the American Heart Association and American College of Cardiology, which recommend that exercise treadmill testing should remain the initial test for both women and men who require evaluation for chest pain, researchers said.
Silent Bundle Branch Problem Seen in Young
Young Swiss army recruits exhibited a large number of ECG abnormalities, but none had atrial fibrillation or flutter, researchers found.
Of the more than 40,000 young conscripts (mean age 19, 134 women) analyzed by 12-lead ECG, incomplete right bundle branch block (13.5%) was the most prevalent abnormality, followed by left fascicular block (0.83%), and first-degree atrioventricular block (0.8%), reported Paul Erne, MD, of Luzerner Kantonsspital in Luzern, Switzerland, and colleagues.
T-wave abnormalities (>2 mm in >2 adjacent leads), a nonspecific warning sign of sudden cardiac death risk, were found in only 0.09%, with minor T-wave changes found in 0.4%, according to the study published in the December issue of HeartRhythm Journal.
The investigators noted that this type of information is known about young competitive athletes, but not for the young population in general.
Peripheral Leg Stenting Shows Success
A trial of femoropopliteal stenting showed good results out to a year, according to results of the MISAGO 2 study.
Of the 671 patients (mean age 68) in the trial who were assessed at 1 year, 90% did not require a repeat procedure, reported Karl-Ludwig Schulte, MD, of Charité Humboldt University Berlin in Germany, and colleagues.
Event-free survival was 85%, and three-quarters of patients reported significant improvements in ischemic symptoms (mean ankle-brachial index improved by ≥0.1). Also, nearly 90% had an improvement in Rutherford classification at 1 year, according to the study in the December issue of the Journal of Endovascular Therapy.
The trial is testing the Misago self-expanding rapid-change nitinol stent system (Terumo) in patients with at least 70% occlusion of the femoral or popliteal arteries.
More Warfarin Saves Valve Procedure
Patients with prosthetic aortic valves that have stenosed may need more anticoagulation rather than a new valve, researchers suggested.
In three case series, Azeem Latib, MD, of EMO-GVM Centro Cuore Columbus in Milan, and colleagues showed that the addition of a vitamin K antagonist to single or dual antiplatelet therapy resolved symptoms such as dyspnea and elevated gradients within 2 months.
The first case presented at 6 months post implantation, the second at 15 months, and the third at 2 years, they reported in a research correspondence online in the Journal of the American College of Cardiology. Researchers noted that the thrombus was not visible.
The valve in these cases was the Sapien XT (Edwards Lifesciences). Latib and colleagues said they could not "identify any clinical trigger, sign of myocardial ischemia, or changes in ejection fraction" in these three cases.
Subspecialists for Adult Congenital Heart Disease
The American Board of Medical 51˶ has approved a new specialty certification for adult congenital heart disease.
The subspecialty certification exam will be available in the next 2 to 3 years and will be open to pediatric cardiologists and internal medicine cardiologists who have completed a two-year adult congenital heart disease training program.
The number of children with congenital heart disease reaching adulthood has increase in recent decades, even surpassing the number of pediatric patients needing care, but only about half of these adults receive any sort of cardiovascular care, according to a statement from the American College of Cardiology (ACC).
"The certification in adult congenital heart disease subspecialty allows this growing group of patients to have their unique cardiac needs met and lifts some of the burden on pediatric cardiologists who may not be appropriately trained in adult health issues," said William Zoghbi, MD, president of the ACC, in a statement.
From the American Heart Association: