Dr Fox fails to acknowledge that stress testing offers considerably more information than the predictive value of the presence of an obstructive lesion of coronary artery disease. A high level of functional capacity and normal hemodynamics is a powerful predictor of a favorable prognosis, so the risk of sudden death in those patients with angina is very low. Stress testing interpretation also utilizes other variables in predicting outcomes beyond ST segment changes, and there are a number of standardized predictive nomograms utilizing additional variables, including functional capacity, heart rate recovery, and systolic blood pressure recovery, which enhance the predictive value of stress testing. As Dr Fox’s analysis clearly points out, however, until more helpful noninvasive testing is available, we are limited in our diagnostic capabilities. Since doing angiograms on all patients with chest pain is not reasonable, a carefully constructed clinical evaluation plan using the best tests available, with their inherent limitations of predictive value, is the best we can offer.
Sharonne N. Hayes, MD, FACC,
Mayo Clinic College of Medicine, Director,
Mayo Clinic Women’s Heart Clinic, Rochester, Minn;
Patrick McBride, MD, MPH,
Department of Medicine (Cardiovascular Medicine) and Family Medicine, Director,
UW Preventive Cardiology, University of Wisconsin, Madison
The following sentence appeared on page 805 of the September issue:
“A case-control study in Bangladesh suggests that breastfed infants have a higher incidence of rotavirus diarrhea, but selection of diarrhea patients as controls may have underestimated the protective effect.”
It should have read as follows:
“A case-control study in Bangladesh suggests that breastfed infants have a higher incidence of rotavirus diarrhea, and although breastfeeding was not found to provide overall protection from developing gastroenteritis, exclusive breastfeeding appeared to protect against severe rotavirus diarrhea for infants less than two years of age.”