German researchers have found that heart disease of the left main coronary artery is often an inherited condition that clusters in families. Moreover, they discovered that initially healthy siblings of a person with the condition were 2.5 times more likely to go on to develop some form of heart disease than were siblings of a patient with heart disease that did not relate to the left main coronary artery.

Writing in the European Heart Journal, the researchers say these findings have important clinical implications because it would be possible to set up more intensive screening and prevention strategies for people known to come from families where other members had left main coronary artery disease (LMD).

They also found that in families where two or more siblings were already suffering from heart disease, if one had left main coronary artery disease (LMD), the other affected siblings were over three times more likely to suffer an LMD-related recurrence.

Professor Heribert Schunkert, head of cardiology at the University of Luebeck (Luebeck, Germany) and lead researcher of the study, said: "Although other studies have shown that myocardial infarction [MI] and coronary artery disease [CAD] run in families, few have examined the role of specific morphologic disease characteristics. In our study we focused on the coronary disease pattern underlying CAD and found that, for LMD, nearly half (49%) of the phenotypic variation that is due to genetic effects was inherited. This substantial heritability is even higher than that for CAD or MI in general.

"This knowledge of coronary morphology may increase our ability to predict disease. In addition, it may help us to find susceptibility factors that underlie the complex causes of heart disease."

Prof Schunkert and Marcus Fischer, MD, and his colleagues from the University of Regensburg (Regensburg, Germany) analyzed coronary angio-grams from 1,801 patients from families with two or more siblings affected by CAD. They found LMD (defined as 50% or greater narrowing of the left main coronary artery) in 12% of the patients. "This reflected the familial accumulation of this condition in high risk CAD families," Schunkert said. 'These data suggest that, not only does LMD cluster in families, but also that the outbreak of the disease at the same location in the coronary tree relates to the genetic basis of this disease." He said that the likelihood of a sibling presenting with LMD when another sibling was affected by the condition was 3.6.

In a parallel study, the researchers followed 1,369 healthy siblings of CAD patients for about five years. During this time, 79 of the healthy siblings either had a heart attack or required heart surgery or both.

LMD was found more frequently in those families where the initially healthy sibling subsequently developed heart disease (13.9 vs 6.4%), and there was a 2.5 times higher risk for the healthy sibling to develop heart disease in families with an LMD sibling compared to families where the patient suffered from some other form of heart disease.

Prof Schunkert said, "Remarkably, the risk in these siblings was significantly higher than that in siblings with a strong positive family history of heart disease, including premature MI in addition to CAD manifestations other than LMD."

He added: "The high heritability of LMD may have important clinical implications with respect to screening strategies. Despite a decline in CAD mortality over the last decade, only a small proportionate change has been seen in the characteristics of unexpected cardiac deaths or survived MIs. The majority of these events is sudden and occurs out of hospital.

"Although the presence of clinically symptomatic CAD markedly increases the risk of MI, over half of sudden cardiac death victims were asymptomatic before the event. A major challenge for heart disease screening is to define populations in which the chance to detect relevant coronary atherosclerosis is high enough to justify the costs and risks of in-depth testing."

He said the tests to determine this problem could include non-invasive coronary angiography, "which could be used to identify lesions in or near the left main coronary artery. In this context, asymptomatic siblings from families with the occurrence of LMD might benefit from intensified screening and prevention strategies."

German research backs day/night readings of BP

Blood pressure should be monitored throughout the whole 24-hour period, with the value of each daytime and night-time blood pressure dependent on outcome being measured, according to a recent report in The Lancet.

Professor Jan Staessen, Department of Cardiovascular Diseases, University of Leuven (Leuven, Belgium). and his research team examined 7,458 individuals, average age 56.8 years, in Asia, South America and Europe and followed them for nearly 10 years.

The researchers found that daytime blood pressure adjusted for night-time blood pressure predicts fatal/non-fatal cardiovascular events.

On the other hand, the use of antihypertensive medications for patients whose readings may be lower during the day, but not at night, may mask the relationship between outcome and daytime blood pressure, the researchers conclude from the data.

The raised mortality among patients with night-time blood pressures higher than during daytime most likely indicates reverse causality, the researchers say.

The researchers also say that individuals with systolic night-to-day ratio values of one or more tended to be older, at higher risk of death, and died at an older age, compared to people whose night-to-day ratio was normal, between 0.8 and 0.9.

The researchers conclude: "The night-time blood pressure predicted mortality and non-fatal outcomes, irrespective of treatment status. The daytime blood pressure independently predicted the composite of all fatal and non-fatal cardiovascular events, especially in untreated participants. Our findings therefore support recording the ambulatory blood pressure during the whole day."

In an editorial accompanying the study, Professor St phane Laurent of H pital Europe n Georges Pompidou and Universit Paris-Descartes (Paris), writes, "Although the findings of Staessen and colleagues are in favor of recording the ambulatory blood pressure for the whole day, the question arises as to whether 24-hour blood pressure values from patients taking antihypertensive therapy should be interpreted differently from those of untreated participants." He said that the study results "have important clinical implications and significantly affect the next guidelines for ambulatory blood pressure measurement."

Sahlgrenska Hospital in TAH-t implant training

Late last month, the heart transplant team from Sahlgrenska University Hospital (Gothenburg, Sweden) — including Dr. Lars Wiklund, chief of cardiothoracic surgery, and cardiothoracic surgeon Dr. Ulf Kjellman — received the first phase of certification training in Berlin to implant the CardioWest temporary Total Artificial Heart (TAH-t) made by SynCardia Systems (Tucson, Arizona).

Sahlgrenska University Hospital is the largest hospital in northern Europe, with more than 2,700 beds and 140 departments. SynCardia said Sweden joins Germany, France and Austria as the fourth European country with a hospital certified to implant the world's only FDA- and CE-mark-approved temporary artificial heart.

The company said there now are 22 TAH-t certified centers, 11 in the U.S. and 11 in Europe. It said that Sahlgrenska University Hospital is the 12th hospital in Europe and the 25th center in the world to complete the first phase of TAH-t certification training.

The CardioWest TAH-t is approved as a bridge to transplant for patients suffering end-stage biventricular failure.

Cardica, Life Recovery receiving CE mark approvals

Cardica (Redwood City, California) reported that it has received the CE mark for its C-Port Flex A anastomosis system. The C-Port Flex A system is a variation of Cardica's C-Port xA Distal Anastomosis System product line and further facilitates the automated anastomosis, or attachment of blood vessels and grafts, during less-invasive coronary artery bypass graft (CABG) procedures.

The company said two independent groups of cardiothoracic surgeons in the U.S. recently performed minimally invasive, closed-chest bypass procedures using the C-Port Flex A anastomosis system and the da Vinci surgical system from Intuitive Surgical (Sunnyvale, California).

"We continue to receive positive feedback from cardiothoracic surgeons in the U.S. who are using the C-Port Flex A to perform ground-breaking closed- chest and beating heart procedures," said Bernard Hausen, MD, PhD, president/CEO of Cardica.

He added that the C-Port Flex A "is designed to enable surgeons to create compliant, reliable anastomoses in sternum-sparing bypass procedures, even in difficult to reach areas of the heart."

The C-Port Flex A system features several modifications to Cardica's C-Port xA system, which is designed to enable automated, reliable and reproducible connections of blood vessels during CABG surgery. The C-Port Flex A system has a flexible, rather than rigid, shaft; is effective in creating compliant anastomoses in vessels as small as one millimeter in internal diameter; and, can be used in either on- or off-pump CABG procedures.

The company said the flexible shaft allows surgeons to position the device to create a secure connection even in difficult to reach areas of the heart. The Flex A received 510(k) clearance from the FDA in March.

"We believe the C-Port Flex A system brings us several steps closer to the possibility of performing truly minimally invasive cardiac surgery with significant benefits for the patient due to less trauma and a faster recovery time compared to a traditional open heart bypass procedure," said Stefano Demertzis, MD, PhD, senior cardiac surgeon at Cardiocentro Ticino (Lugano, Switzerland).

Life Recovery Systems (LRS; Alexandria, Louisiana) reported that its ThermoSuit system also has been granted CE-mark approval for temperature reduction in patients, such as to induce hypothermia to preserve cardiac and brain function in victims of cardiac arrest, stroke, heart attack, traumatic brain injury and hyperthermia.

The ThermoSuit System, which rapidly cools a patient's core temperature, consists of a disposable body suit and a means to pump coolant within the suit over the skin of the patient. LRS said it is the first device for patient temperature management that provides a thin layer of rapidly flowing liquid coolant in direct contact with the skin.

"This approach gives the ThermoSuit System outstanding capabilities to rapidly and non-invasively change patient temperature," the company said. "It has been designed for ease of use for clinicians who treat patients indicated for cooling therapy, and has the potential to quickly cool these patients conveniently and rapidly."

Life Recovery said that evolving international standards of care recommend that "unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32 to 34 degrees C for 12 to 24 hours when the initial rhythm was ventricular fibrillation. Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.

Also approved ...

"The Sorin Group (Denver, Colorado) reported that it received FDA approval for its MEMO 3D semirigid annuloplasty ring. Annuloplasty rings are indicated for repair of the mitral valve and are designed to remodel the anatomical shape of the mitral annulus, preventing further dilatation and minimizing the risk of late repair failures.

Sorin said that the MEMO 3D has already been introduced in Europe.