Heart Rate Effects of Longboard Skateboarding

The longboard skateboard has a longer, and usually wider, deck than the standard skateboard to provide greater support for the rider during the higher speeds attained on this version of the skateboard. Fourteen volunteer subjects participated in downhill and uphill longboarding trials. Heart rates were monitored during both trials, and the downhill and uphill average heart rates were compared with resting heart rates and then compared with accepted intensity recommendations for health and fitness benefits. The study questions were: Does longboarding have an acute effect on heart rates? If so, will longboarding uphill and/or downhill cause heart rate changes to levels recommended to improve cardiorespiratory health and fitness? With these questions as guidance we developed four hypotheses. With beats/minute and average uphill heart rate of 167.8 beats/minute statistical analysis showed statistically significant p values < .0001 and each null hypothesis was rejected in favor of their respective research hypotheses. Based on average age and average resting heart rate, average age-predicted maximum heart rate was 193.2 beats/minute and heart rate reserve was 133.2 beats/minute. The average percentages of heart rate reserve for the downhill section (131.4 beats/minute) and uphill section )(167.8 beats/minute) were 54% and 81% respectively. Downhill heart rates are within moderate intensity levels, 40% to 60% of heart rate reserve, and uphill heart rates are within vigorous intensity levels, greater than 60% of heart rate reserve. These results indicate that longboarding can increase heart rate to suggested levels suggested by the American College of Sports Medicine for improving cardiovascular health and fitness.

Eotaxin/CCL11 expression by infiltrating macrophages in rat heart transplants during ongoing acute rejection

Eotaxin/CCL11 chemokine is expressed in different organs, including the heart, but its precise cellular origin in the heart is unknown. Eotaxin is associated with Th2-like responses and exerts its chemotactic effect through the chemokine receptor-3 (CCR3), which is also expressed on mast cells (MC). The aim of our study was to find the cellular origin of eotaxin in the heart, and to assess whether expression is changing during ongoing acute heart transplant rejection, indicating a correlation with mast cell infiltration which we observed in a previous study. In a model of ongoing acute heart transplant rejection in the rat, we found eotaxin mRNA expression within infiltrating macrophages, but not in mast cells, by in situ-hybridization. A five-fold increase in eotaxin protein in rat heart transplants during ongoing acute rejection was measured on day 28 after transplantation, compared to native and isogeneic control hearts. Eotaxin concentrations in donor hearts on day 28 after transplantation were significantly higher compared to recipient hearts, corroborating an origin of eotaxin from cells within the heart, and not from the blood. The quantitative comparison of eotaxin mRNA expression between native hearts, isografts, and allografts, respectively, revealed no statistically significant difference after transplantation, probably due to an overall increase in the housekeeping gene's 18S rRNA during rejection. Quantitative RT-PCR showed an increase in mRNA expression of CCR3, the receptor for eotaxin, during ongoing acute rejection of rat heart allografts. Although a correlation between increasing eotaxin expression by macrophages and mast cell infiltration is suggestive, functional studies will elucidate the role of eotaxin in the process of ongoing acute heart transplant rejection.

Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.

[Bone density and laboratory parameters of bone metabolism in patients with terminal heart disease]

The purpose of this study was to assess bone mineral density (BMD) and parameters for bone metabolism in patients with end-stage heart disease awaiting heart transplantation to determine whether these patients are at increased risk of bone disease.

Characterization of recombinant class I MHC alloantigen action upon the survival of disparate heart allografts

Previous studies have led to the development of allochimeric class I MHC proteins as agents that effectively induce donor-specific transplantation tolerance in a rat system with or without additional immunosuppression. Within the α1-helical region of RT1.Au, an epitope that conferred immunologic tolerance was discovered. Studies presented herein were designed to test our central hypothesis that allochimeric proteins onfer tolerance in a mouse model. To test this hypothesis, portal vein (PV) injection of wild-type H2Kd and H2Dd proteins were produced in a bacterial expression system and found to specifically prolong the survival of BALB/c (H2d) heart allografts in C57BL/10 (H2b) recipients. Although a single PV injection of 50 μg α1–α 3 H2Kd alone was ineffective, 50 μg α1 –α3 alone slightly prolonged BALB/c heart allograft survivals. In contrast, the combination of 25 μg α1–α 3 H2Kd and 25 μg α1–α 3 H2Dd proteins prolonged BALB/c graft survivals to 20.2 ± 6.4 days (p < 0.004). The effect was donor-specific, since a combination of 25 μg α1–α3 H2Kd and 25 μg α1–α3 H2Dd proteins failed to affect survivals of third-party C3H (H2k k) heart allografts, namely 9.0 ± 0.0 days in treated versus 7.8 ± 0.5 days in untreated hosts. Thus, the combination of two H2K d and H2Dd proteins is more effective in prolonging allograft survival than a single protein produced in a bacterial expression system. A single PV injection (day 0) of 25 μg α1–α 2 H2Kd and 25 μg α1–α 2 H2Dd proteins to C57BL/10 mice prolonged the survival of BALB/c heart allografts to 22.4 ± 4.5 days. Within a WF to ACI rat heart allograft system, a single PV injection of 20 μg 70–77 u-RT1.Aa induced specific tolerance of allografts. This therapy could be combined with CsA to induce transplantation tolerance. However, combination of 70–77u-RT1.Aa with CTLA4Ig, rapamycin, or AG-490 effectively blocked the induction of transplantation tolerance. Tolerance generated by allochimeric protein could be adoptively transferred to naive recipients. Intragraft cytokine mRNA levels showed a bias towards a Th2-type phenotype. Additionally, studies of cytokine signaling and activation of transcription factors revealed a requirement that these pathways remain available for signaling in order for transplantation tolerance to occur. These studies suggest that the generation of regulatory cells are required for the induction of transplantation tolerance through the use of allochimeric proteins. ^

La iglesia de Santiago de los españoles en Roma y su entorno entre los siglos XV y XIX. Una historia a través del dibujo

Plaza Navona representa una de las visitas obligadas de Roma, pero solo algunos advertirán en ella la presencia española en la sala de exposiciones del Instituto Cervantes o en la inmediata Libreria Española. Todavía serán menos los que se percatarán de la huella española dejada en aquella iglesia de fachada anónima situada, en el extremo sur de la plaza: la antigua iglesia de Santiago de los Españoles. La presente tesis pretende, utilizando el dibujo como guía, herramienta y fin del proceso de análisis y estudio, reconstruir el proceso de conformación y construcción de la que fue iglesia española principal, cuya fundación hace patente el destacado papel jugado por la “nación” castellana en Roma durante la Edad Media; y en torno a la que se aglutinaron las actividades religiosas, diplomáticas y financieras de los castellanos que vivieron en la actual capital italiana. Se intentará recrear en el tiempo la que es hoy la iglesia de Nuestra Señora del Sagrado Corazón, sometiéndola a una restitución gráfica disciplinada, homogénea y objetiva en la medida de lo posible de las varias etapas que la han caracterizadas, desde su fundación hasta cuando en 1878 España se deshizo de ella, ya en ruina, vendiéndola. Como nos comenta Gaetano Moroni, de todas las comunidades nacionales que se encontraban en Roma la española parece ser efectivamente una de las más rica y prestigiosa. Aunque lo que no cuenta Moroni no haya sido todavía demostrado, dicho enunciado resulta de todas formas interesante puesto que pone el acento sobre el hecho de que ya desde el siglo X parece ser habitual de ocupar y reutilizar antiguas ruinas, usándolas como base para la construcción de hospitales para los peregrinos. Esta operación se hizo particularmente frecuente sobre todo antes del Gran Jubileo de 1450: de hecho desde la primera mitad del Quattrocento se fundan distintas iglesias y hospitales nacionales para acoger y prestar una adecuada asistencia y socorro a los innumerables peregrinos que llegaban a la ciudad, edificios que se van construyendo sobre los restos de antiguos edificios de época romana. Prueba de ello es en efecto la fundación originaria de la iglesia y hospital de los Españoles que, parte del conjunto de edificios que compone la Plaza Navona, situada en el corazón de Campo Marzio y cuya posición y forma corresponden a la del antiguo Estadio de Domiciano, y que ahora es en sus dimensiones, en su imagen arquitectónica y en su consistencia material, el resultado de la definición proyectual y de las transformaciones que se llevaron a cabo sobre lo que quedaba del antiguo templo español del siglo XV, entre finales del ‘800 y los años 30 del siglo XX . Transformaciones devastadoras, huellas grabadas o canceladas que encuentran una justificación en los acontecimientos históricos reflejados en el patrimonio urbano. El análisis de todas las fuentes permite trazar, si no la totalidad, buena parte de las modificaciones que la antigua iglesia de Santiago ha sufrido. La construcción del templo se puede dividir en tres momentos decisivos: una primera etapa de fundación en 1450-1478 en la que la iglesia tenía fachada y entrada en via de la Sapienza, hoy Corso Rinascimento; una segunda de significativa ampliación hacia Plaza Navona con una nueva fachada monumental hacia ese espacio público en 1496-1500; y una última importante ampliación entre 1525-1526, llevada a cabo por el arquitecto Antonio da Sangallo el Joven. Tras la intensa vida del templo, en el siglo XVIII, éste cae en ruina y finalmente es vendido en 1878 a la orden de los misioneros franceses de Nuestra Señora del Sagrado Corazón que la reconvierten en iglesia reformando totalmente el conjunto en 1881, según proyecto de Luca Carimini. En 1936, en plena fase de rectificación de trazados urbanos por obra del régimen fascista, según proyecto de Arnaldo Foschini, se mutila su extremidad hacia vía de la Sapienza dejando su estado tal y como se contempla en la actualidad. ABSTRACT The objective of this thesis is the reconstruction of the design and edification process -using drawings and sketches as a guide, tool and the end of the analytical process- of a church which was once the preeminent Spanish church in medieval Rome, known today as Nostra Signora del Sacro Cuore (Our Lady of the Sacred Heart). The founding of this church illustrates the important role held by the Castillian “nation” in Rome during the Middle Ages. It was the focal point of all the religious, diplomatic and economic activities of the Castillian community residing in today’s Italian capital. The aim of this proyect is a recreation the church in time by submitting it to a disciplined, homogenous and objective graphic restitution of the various stages most characteristic the temple, starting from its foundation until 1878 when, in a state of ruins, the church was finally sold off by Spain. Gaetano Moroni once commented that of all the international communities found in Rome, the Spanish community seemed to be one of the wealthiest and most prestigious. Such a statement proves interesting as it emphasizes that starting in the 10th century we see there was a widespread custom of occupying and reusing old ruins for use as the bases of new constructions of hospitals for pilgrims. This custom became especially frequent just before the Jubilee Year of 1450: in fact, in the first half of the Quattrocento we see the founding of many different national churches and hospitals which provided shelter and care to the countless pilgrims arriving in the city, buildings which were constructed on top of the ruins of ancient buildings left over from Roman times. Proof of this is the original foundation of the Spanish church and hospital forming part of the Piazza Navona, built upon and following the outline of the Stadium of Domitian, in the heart of Campo Marzio. Now, in its dimensions, its architectural image and its material substance, it represents the predominant result of the planning definitions and the transformations which affected the old 15th-century Spanish temple. Ocurring between the end of the 19th century and the 1930s, the transformations were devastating, erasing original peculiarities and engraving new ones, transformations made justifiable by the historical events reflected in its urban environs. Analyzing all sources allows us to trace, even if not in entirety, still a sizeable portion of the modifications undergone by the old Church of Saint James. The construction of the temple can be divided into three decisive moments: its foundation, from 1450 to 1478, when the church’s façade and main door looked out on to the Via della Sapienza, today’s central avenue of Corso del Rinascimento; the second stage being a major expansion towards the Piazza Navona (1496-1500) with a new, monumental façade facing the public space; and the third was the last significant expansion, carried out from 1525 to 1526 by the architect Antonio da Sangallo the Younger. Despite an intense and bustling life during the Modern Age, in the 18th century the church began to fall into ruin and was finally sold in 1878 to the order of French missionaries of Our Lady of the Sacred Heart, who reconverted it into a church and completely renovated the structure in 1881 in a project supervised by Luca Carimini. In 1936, the corrective urban redesign of Rome carried out by the fascist regime and implemented by Arnaldo Foschini mutilated the part bordering Via della Sapienza, leaving it as we see it today.

Distinct spectra of somatic mutations accumulated with age in mouse heart and small intestine

Somatic mutation accumulation has been implicated as a major cause of cancer and aging. By using a transgenic mouse model with a chromosomally integrated lacZ reporter gene, mutational spectra were characterized at young and old age in two organs greatly differing in proliferative activity, i.e., the heart and small intestine. At young age the spectra were nearly identical, mainly consisting of G·C to A·T transitions and 1-bp deletions. At old age, however, distinct patterns of mutations had developed. In small intestine, only point mutations were found to accumulate, including G·C to T·A, G·C to C·G, and A·T to C·G transversions and G·C to A·T transitions. In contrast, in heart about half of the accumulated mutations appeared to be large genome rearrangements, involving up to 34 centimorgans of chromosomal DNA. Virtually all other mutations accumulating in the heart appeared to be G·C to A·T transitions at CpG sites. These results suggest that distinct mechanisms lead to organ-specific genome deterioration and dysfunction at old age.

Screening for hypercholesterolaemia in primary care: randomised controlled trial of postal questionnaire appraising risk of coronary heart disease

Objectives: To validate a self administered postal questionnaire appraising risk of coronary heart disease. To determine whether use of this questionnaire increased the percentage of people at high risk of coronary heart disease and decreased the percentage of people at low risk who had their cholesterol concentration measured.

Cystic fibrosis gene encodes a cAMP-dependent chloride channel in heart.

cAMP-dependent chloride channels in heart contribute to autonomic regulation of action potential duration and membrane potential and have been inferred to be due to cardiac expression of the epithelial cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. In this report, a cDNA from rabbit ventricle was isolated and sequenced, which encodes an exon 5 splice variant (exon 5-) of CFTR, with >90% identity to human CFTR cDNA present in epithelial cells. Expression of this cDNA in Xenopus oocytes gave rise to robust cAMP-activated chloride currents that were absent in control water-injected oocytes. Antisense oligodeoxynucleotides directed against CFTR significantly reduced the density of cAMP-dependent chloride currents in acutely cultured myocytes, thereby establishing a direct functional link between cardiac expression of CFTR protein and an endogenous chloride channel in native cardiac myocytes.

Miroir du clergé.

Title pages of both volumes bear epigraphs by Saint Bernard and decorative vignettes. Vignette on t.p. of vol. 2 shows the Sacred Heart of Jesus on an opened book.

Physiological thermoregulation in a crustacean? Heart rate hysteresis in the freshwater crayfish Cherax destructor

Differential heart rates during heating and cooling (heart rate hysteresis) are an important thermoregulatory mechanism in ectothermic reptiles. We speculate that heart rate hysteresis has evolved alongside vascularisation, and to determine whether this phenomenon occurs in a lineage with vascularised circulatory systems that is phylogenetically distant from reptiles, we measured the response of heart rate to convective heat transfer in the Australian freshwater crayfish, Cherax destructor. Heart rate during convective heating (from 20 to 30 degreesC) was significantly faster than during cooling for any given body temperature. Heart rate declined rapidly immediately following the removal of the heat source, despite only negligible losses in body temperature. This heart rate 'hysteresis' is similar to the pattern reported in many reptiles and, by varying peripheral blood flow, it is presumed to confer thermoregulatory benefits particularly given the thermal sensitivity of many physiological rate functions in crustaceans. (C) 2004 Published by Elsevier Inc.

The development and investigation of a novel pulsatile heart assist device

Cardiovascular diseases (CVD) contributed to almost 30% of worldwide mortality; with heart failure being one class of CVD. One popular and widely available treatment for heart failure is the intra-aortic balloon pump (IABP). This heart assist device is used in counterpulsation to improve myocardial function by increasing coronary perfusion, and decreasing aortic end-diastolic pressure (i.e. the resistance to blood ejection from the heart). However, this device can only be used acutely, and patients are bedridden. The subject of this research is a novel heart assist treatment called the Chronic Intermittent Mechanical Support (CIMS) which was conceived to offer advantages of the IABP device chronically, whilst overcoming its disadvantages. The CIMS device comprises an implantable balloon pump, a percutaneous drive line, and a wearable driver console. The research here aims to determine the haemodynamic effect of balloon pump activation under in vitro conditions. A human mock circulatory loop (MCL) with systemic and coronary perfusion was constructed, capable of simulating various degrees of heart failure. Two prototypes of the CIMS balloon pump were made with varying stiffness. Several experimental factors (balloon inflation/deflation timing, Helium gas volume, arterial compliance, balloon pump stiffness and heart valve type) form the factorial design experiments. A simple modification to the MCL allowed flow visualisation experiments using video recording. Suitable statistical tests were used to analyse the data obtained from all experiments. Balloon inflation and deflation in the ascending aorta of the MCL yielded favourable results. The sudden balloon deflation caused the heart valve to open earlier, thus causing longer valve opening duration in a cardiac cycle. It was also found that pressure augmentation in diastole was significantly correlated with increased cardiac output and coronary flowrate. With an optimum combination (low arterial compliance and low balloon pump stiffness), systemic and coronary perfusions were increased by 18% and 21% respectively, while the aortic end-diastolic pressure (forward flow resistance) decreased by 17%. Consequently, the ratio of oxygen supply and demand to myocardium (endocardial viability ratio, EVR) increased between 33% and 75%. The increase was mostly attributed to diastolic augmentation rather than systolic unloading.

Defective peroxisomal proliferators activated receptor gamma activity due to dominant-negative mutation synergizes with hypertension to accelerate cardiac fibrosis in mice

Aims: Humans with inactivating mutations in peroxisomal proliferators activated receptor gamma (PPAR?) typically develop a complex metabolic syndrome characterized by insulin resistance, diabetes, lipodystrophy, hypertension, and dyslipidaemia which is likely to increase their cardiovascular risk. Despite evidence that the activation of PPAR? may prevent cardiac fibrosis and hypertrophy, recent evidence has suggested that pharmacological activation of PPAR? causes increased cardiovascular mortality. In this study, we investigated the effects of defective PPAR? function on the development of cardiac fibrosis and hypertrophy in a murine model carrying a human dominant-negative mutation in PPAR?. Methods and results: Mice with a dominant-negative point mutation in PPAR? (P465L) and their wild-type (WT) littermates were treated with either subcutaneous angiotensin II (AngII) infusion or saline for 2 weeks. Heterozygous P465L and WT mice developed a similar increase in systolic blood pressure, but the mutant mice developed significantly more severe cardiac fibrosis to AngII that correlated with increased expression of profibrotic genes. Both groups similarly increased the heart weight to body weight ratio compared with saline-treated controls. There were no differences in fibrosis between saline-treated WT and P465L mice. Conclusion: These results show synergistic pathogenic effects between the presence of defective PPAR? and AngII-induced hypertension and suggest that patients with PPAR? mutation and hypertension may need more aggressive therapeutic measures to reduce the risk of accelerated cardiac fibrosis. © The Author 2009.

New Library-curated Faculty Profile Platform Launches Through bepress

As faculty needs evolve and become increasingly digital, libraries are feeling the pressure to provide relevant new services. At the same time, faculty members are struggling to create and maintain their professional reputations online. We at bepress are happy to announce the new SelectedWorks, the fully hosted, library-curated faculty profile platform that positions the library to better support faculty as well as the institution at large. Beverly Lysobey, Digital Commons and Resource Management Librarian, at Sacred Heart University, says: “Both faculty and administration have been impressed with the services we provide through SelectedWorks; we’re able to show how much our faculty really publishes, and it’s great for professors to get that recognition. We’ve had several faculty members approach us for help making sure their record was complete when they were up for tenure, and we’ve even found articles that authors themselves no longer had access to.” With consistent, organized, institution-branded profiles, SelectedWorks increases campus-wide exposure and supports the research mission of the university. As the only profile platform integrated with the fully hosted Digital Commons suite of publishing and repository services, it also ensures that the institution retains management of its content. Powerful integration with the Digital Commons platform lets the home institution more fully capture the range of scholarship produced on campus, and hosted services facilitate resource consolidation and reduces strain on IT. The new SelectedWorks features a modern, streamlined design that provides compelling display options for the full range of faculty work. It beautifully showcases streaming media, images, data, teaching materials, books – any type of content that researchers now produce as part of their scholarship. Detailed analytics tools let authors and librarians measure global readership and track impact for a variety of campus stakeholders: authors can see the universities, agencies, and businesses that are reading their work, and can easily export reports to use in tenure and promotion dossiers. Janelle Wertzbeger, Assistant Dean and Director of Scholarly Communications at Gettysburg College’s Musselman Library, says, “The new author dashboard maps and enhanced readership are SO GOOD. Every professor up for promotion & tenure should use them!” And of course, SelectedWorks is fully backed by the continual efforts of the bepress development team to provide maximum discoverability to search engines, increasing impact for faculty and institutions alike: Reverend Edward R. Udovic, Vice President for Teaching and Learning Resources at DePaul University, says, “In the last several months downloads of my scholarship from my [SelectedWorks] site have far surpassed the total distribution of all my work in the previous twenty five years.”

The role of heart rate as a risk marker for predicting adverse outcomes

Cardiovascular disease is one of the leading causes of death around the world. Resting heart rate has been shown to be a strong and independent risk marker for adverse cardiovascular events and mortality, and yet its role as a predictor of risk is somewhat overlooked in clinical practice. With the aim of highlighting its prognostic value, the role of resting heart rate as a risk marker for death and other adverse outcomes was further examined in a number of different patient populations. A systematic review of studies that previously assessed the prognostic value of resting heart rate for mortality and other adverse cardiovascular outcomes was presented. New analyses of nine clinical trials were carried out. Both the original and extended Cox model that allows for analysis of time-dependent covariates were used to evaluate and compare the predictive value of baseline and time-updated heart rate measurements for adverse outcomes in the CAPRICORN, EUROPA, PROSPER, PERFORM, BEAUTIFUL and SHIFT populations. Pooled individual patient meta-analyses of the CAPRICORN, EPHESUS, OPTIMAAL and VALIANT trials, and the BEAUTIFUL and SHIFT trials, were also performed. The discrimination and calibration of the models applied were evaluated using Harrell’s C-statistic and likelihood ratio tests, respectively. Finally, following on from the systematic review, meta-analyses of the relation between baseline and time-updated heart rate, and the risk of death from any cause and from cardiovascular causes, were conducted. Both elevated baseline and time-updated resting heart rates were found to be associated with an increase in the risk of mortality and other adverse cardiovascular events in all of the populations analysed. In some cases, elevated time-updated heart rate was associated with risk of events where baseline heart rate was not. Time-updated heart rate also contributed additional information about the risk of certain events despite knowledge of baseline heart rate or previous heart rate measurements. The addition of resting heart rate to the models where resting heart rate was found to be associated with risk of outcome improved both discrimination and calibration, and in general, the models including time-updated heart rate along with baseline or the previous heart rate measurement had the highest and similar C-statistics, and thus the greatest discriminative ability. The meta-analyses demonstrated that a 5bpm higher baseline heart rate was associated with a 7.9% and an 8.0% increase in the risk of all-cause and cardiovascular death, respectively (both p less than 0.001). Additionally, a 5bpm higher time-updated heart rate (adjusted for baseline heart rate in eight of the ten studies included in the analyses) was associated with a 12.8% (p less than 0.001) and a 10.9% (p less than 0.001) increase in the risk of all-cause and cardiovascular death, respectively. These findings may motivate health care professionals to routinely assess resting heart rate in order to identify individuals at a higher risk of adverse events. The fact that the addition of time-updated resting heart rate improved the discrimination and calibration of models for certain outcomes, even if only modestly, strengthens the case that it be added to traditional risk models. The findings, however, are of particular importance, and have greater implications for the clinical management of patients with pre-existing disease. An elevated, or increasing heart rate over time could be used as a tool, potentially alongside other established risk scores, to help doctors identify patient deterioration or those at higher risk, who might benefit from more intensive monitoring or treatment re-evaluation. Further exploration of the role of continuous recording of resting heart rate, say, when patients are at home, would be informative. In addition, investigation into the cost-effectiveness and optimal frequency of resting heart rate measurement is required. One of the most vital areas for future research is the definition of an objective cut-off value for the definition of a high resting heart rate.