EDITORIAL COMMENT

Another Cardiology Journal – Why?

During the 1980’s and 1990’s the frequency of published medical case reports and reviews of the literature with medical students, residents and cardiovascular fellows as senior authors was drastically reduced. There were many reasons for this reduction and numerous physicians in the formative period of their training were not afforded the publication opportunity of their predecessors.

Reflecting back on my own career it is obvious that many of the case reports I authored or co-authored were interesting yet their impact on the general body of medical knowledge was minimal. The “first description of ” or an “unusual variant of ” rarely provides a significant addition to the foundation of evidence-based medicine. Examination of the curriculum vitae of many accomplished cardiologists and researchers will probably reveal that many if not most, published articles based on a single case or a small group of subjects during the early years of their careers. Clearly, being a senior author on a peer-reviewed published paper at that early stage of training is exciting and may provide an impetus for participating in further research. In my personal experience I can cite a few examples of single or small study group articles which apparently did have an impact: the initial description of cocaine-induced ventricular arrhythmia, positional atrial flutter, intravenous carbenicillin resulting in profound hypokalemia, constrictive pericarditis secondary to coronary bypass surgery, complete heart block resulting from left heart catheterization in a patient with pre-existing right bundle branch block and prolapsing intimal flap creating aortic regurgitation in a patient with aortic dissection. In the latter two cases, these phenomena were recently re-discovered and published in a premier cardiology journal without being cited! I know that at least in one of these cases, an electronic literature search was inadequate and the original description overlooked. Occasionally, a single observation will prompt a national alert from the federal government, such as our observation of intravenous terbutaline inducing angina pectorus in pregnant patient. We also wonder whether or not many of these case reports would have been accepted for publication in the 1990’s or at the current time. Would they have been rejected, with admonitions concerning the requirement for a much larger study group, with statistical analysis for other variables which could account for the findings?

New paper-print and electronic journals serve an extremely important function, namely introduction of trainees to the peer-reviewed research process as authors. The scientific enthusiasm of many young physicians is enhanced by these journals and we need more of them. Cardiologyresearch.org encourages submission of original case reports, clinical research and critical reviews of the literature by medical students, residents and fellows.

Kenneth B. Desser, MD

2004;1:E