Lack of radiological awareness among physicians working in a tertiary-care cardiological centre.

BACKGROUND: Medical irradiation is the most important artificial source of exposure to ionising radiations in Europe and implies biorisks. AIM: To assess the level of radiological awareness in a tertiary-care referral centre of adult-pediatric cardiological excellence. METHODS: One hundred physicians (31 women, age=41+/-8 years) were polled with a simple, one-page, multiple choice questionnaire. Twenty-five physicians worked in a pediatric, 75 in an adult cardiology centre. RESULTS: Eighty-nine of the polled physicians wrongly estimated the contribution of nuclear and radiological tests in overall radiation exposure of average US inhabitant as <0.01% (36% of physicians) or <1% (31%) or <10% (22%) (correct answer given by 11% of physicians: >10%). Ninety-five physicians wrongly estimated the risk of fatal cancer associated with a stress myocardial perfusion scintigraphy procedure as "zero" (48%) or "<1 in 10 million"(19%) or "<1 in 1 million" (28%) (correct answer given by 5%: >1 in 10,000 tests). Seventy-one wrongly estimated the dose exposure of a myocardial stress perfusion scintigraphy as equal to one (13%), or one-half (9%), or three times (49%) that of a chest X-ray (correct answer given by 29%: 500 times). The average level of radiological awareness was not correlated to the number of radiological-nuclear exams performed/prescribed per year and to the type of (adult or pediatric) working environment. CONCLUSION: Physicians working in an adult and pediatric cardiological environment of excellence are largely unaware of environmental impact, biorisks and dose exposure of the ionising exams they prescribe and/or perform daily.

Stress echo in chest pain unit: the SPEED trial.

BACKGROUND: Emergency room (ER) evaluation of patients with acute chest pain and non-diagnostic electrocardiography (ECG) remains a frequent and difficult problem. AIM: To assess safety and prognostic implications of pharmacological stress echocardiography in the ER chest pain unit (CPU). METHODS: A total of 552 patients (321 males, age 58+/-12.6 years) with acute chest pain, negative serial enzymes and/or troponin, and ECG recordings, and normal/unchanged resting left ventricular function were prospectively enrolled and underwent pharmacological (dipyridamole or dobutamine) stress echo. Six echo labs that had passed the preliminary quality control for stress echo reading entered the study. Follow-up was obtained in all patients after a median period of 13 months. RESULTS: No significant adverse events were observed during the test. Stress echocardiography was negative in 502 patients (91%) and positive in 50 (9%). The 502 patients with negative stress echocardiography were discharged with no or unchanged anti-ischemic medications. While the 50 patients with positive stress echo were admitted to the coronary care unit, 44 of these underwent coronary angiography with the result that 42 out of 44 showed significant coronary artery disease. There were 45 events in the follow-up: six in the 502 patients with negative and 39 in the 50 patients with positive stress echo (1.2% vs. 78%, p<0.001). The negative predictive value of stress echocardiography was 98.8% for all events and 99.6% for hard events. CONCLUSIONS: Stress echocardiography is a feasible, safe, and effective tool for early stratification of patients admitted to the ER with acute chest pain and non-ischemic ECG and resting echo.

AMPD1 (C34T) polymorphism and clinical outcomes in patients undergoing myocardial revascularization.

BACKGROUND: C34T variant of adenosine monophosphate deaminase 1 (AMPD1) gene has been associated with a prolonged survival in heart failure and coronary artery disease, hypothetically linked to an enhanced production of adenosine. DESIGN: Since adenosine administration is a promising approach for the prevention of the ischemia-reperfusion in myocardial revascularization, the aim of this study was to investigate whether the AMPD1 (-) allele is associated with a favorable prognosis after coronary revascularization. In addition, we assessed the association between AMPD1 polymorphism and plasma adenosine levels. METHODS: We investigated a total of 161 patients receiving coronary revascularization (70 percutaneous transluminal coronary angioplasty and 91 coronary artery bypass graft). They were investigated for a composite endpoint including recurrent angina, non-fatal MI, target vessel revascularization, heart failure and cardiac death. Plasma adenosine was also measured by high-performance liquid chromatography methods on a subset of 25 patients. RESULTS: During the follow-up period (7.0+/-0.3 months), the overall combined endpoint accounted for 17 events (10 cardiac-related deaths, 6 revascularization procedures and 1 congestive heart failure). The composite endpoint was 9.8% for AMPD1 (-) allele carriers vs. 11.5% for non-carriers (log-rank statistic, p=n.s.). In the logistic analysis only low (