RESUMO
BACKGROUND: Coronary collateral circulation is a common finding in patients with chronic total occlusions (CTOs) resulting from chronic coronary artery disease (CAD). Regional wall motion abnormalities (RWMA) on transthoracic echocardiography (TTE) can be used for the diagnosis of CAD. However, little work has been done to investigate the impact of collateral vessels on the diagnostic accuracy of resting TTE for CAD. METHODS: A retrospective chart review was conducted of adults who received a resting TTE and cardiac catheterization within 30 days over a 4-year period at the Temple Baylor Scott & White echocardiography laboratory. Exclusion criteria included catheterization without coronary angiography and prior history of CAD, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). We analyzed RWMA on TTE in patients with CAD and coronary collateral circulation on cardiac catheterization to assess for correlation. RESULTS: Of the 753 patients were included in this study, 453 had CAD, 272 had both CAD and RWMA, 111 had collateral circulation, and 73 had collateral circulation and RWMA. There was no significant difference in RWMA in patients with CAD with and without collateral circulation. There was no significant difference in the sensitivity (60.0 % vs 59.2 %) and specificity (78.4 % vs 73.9 %) after collateral-adjusted interpretation of RWMA and CAD (p = 0.3). DISCUSSION: Our results suggest the average coronary collateral system is of insufficient clinical significance to prevent the development of RWMA on resting TTE.
RESUMO
Despite uncertain efficacy, cannabinoids and derived products are becoming increasingly used in the field of palliative care for oncologic patients. Cannabinoids chiefly include psychoactive tetrahydrocannabinol (THC) and nonpsychoactive cannabidiol (CBD). Use of and research interest in THC, CBD, and combination THC/CBD products have increased in recent years, particularly after the Agriculture Improvement Act of 2018 made cannabis plants with <0.3% THC no longer controlled substances, and many states recently legalized THC use altogether. To provide an updated review of this topic, we reviewed randomized controlled trials with >50 patients studying cannabinoid use in cancer patients. We found that THC products, including THC and THC/CBD combination products, are helpful for treating chemotherapy-induced nausea/vomiting. CBD products were not helpful for this indication. For most other studied indications (anorexia/cachexia, mood, general global symptoms), there was no convincing evidence to support widespread cannabinoid use in cancer symptom management. The evidence for treating cancer-related pain with THC/CBD products is somewhat conflicting. We conclude that, apart from using THC products to treat chemotherapy-induced nausea/vomiting, cannabinoid products should not be routinely recommended for cancer supportive care. Further research in the form of large randomized controlled trials is warranted in this area.