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1.
AJR Am J Roentgenol ; 219(3): 407-419, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35441530

RESUMEN

BACKGROUND. Deep learning frameworks have been applied to interpretation of coronary CTA performed for coronary artery disease (CAD) evaluation. OBJECTIVE. The purpose of our study was to compare the diagnostic performance of myocardial perfusion imaging (MPI) and coronary CTA with artificial intelligence quantitative CT (AI-QCT) interpretation for detection of obstructive CAD on invasive angiography and to assess the downstream impact of including coronary CTA with AI-QCT in diagnostic algorithms. METHODS. This study entailed a retrospective post hoc analysis of the derivation cohort of the prospective 23-center Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia (CREDENCE) trial. The study included 301 patients (88 women and 213 men; mean age, 64.4 ± 10.2 [SD] years) recruited from May 2014 to May 2017 with stable symptoms of myocardial ischemia referred for nonemergent invasive angiography. Patients underwent coronary CTA and MPI before angiography with quantitative coronary angiography (QCA) measurements and fractional flow reserve (FFR). CTA examinations were analyzed using an FDA-cleared cloud-based software platform that performs AI-QCT for stenosis determination. Diagnostic performance was evaluated. Diagnostic algorithms were compared. RESULTS. Among 102 patients with no ischemia on MPI, AI-QCT identified obstructive (≥ 50%) stenosis in 54% of patients, including severe (≥ 70%) stenosis in 20%. Among 199 patients with ischemia on MPI, AI-QCT identified nonobstructive (1-49%) stenosis in 23%. AI-QCT had significantly higher AUC (all p < .001) than MPI for predicting ≥ 50% stenosis by QCA (0.88 vs 0.66), ≥ 70% stenosis by QCA (0.92 vs 0.81), and FFR < 0.80 (0.90 vs 0.71). An AI-QCT result of ≥ 50% stenosis and ischemia on stress MPI had sensitivity of 95% versus 74% and specificity of 63% versus 43% for detecting ≥ 50% stenosis by QCA measurement. Compared with performing MPI in all patients and those showing ischemia undergoing invasive angiography, a scenario of performing coronary CTA with AIQCT in all patients and those showing ≥ 70% stenosis undergoing invasive angiography would reduce invasive angiography utilization by 39%; a scenario of performing MPI in all patients and those showing ischemia undergoing coronary CTA with AI-QCT and those with ≥ 70% stenosis on AI-QCT undergoing invasive angiography would reduce invasive angiography utilization by 49%. CONCLUSION. Coronary CTA with AI-QCT had higher diagnostic performance than MPI for detecting obstructive CAD. CLINICAL IMPACT. A diagnostic algorithm incorporating AI-QCT could substantially reduce unnecessary downstream invasive testing and costs. TRIAL REGISTRATION. Clinicaltrials.gov NCT02173275.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Isquemia Miocárdica , Imagen de Perfusión Miocárdica , Anciano , Inteligencia Artificial , Angiografía por Tomografía Computarizada/métodos , Constricción Patológica , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estándares de Referencia , Estudios Retrospectivos
2.
Cardiovasc Ultrasound ; 12: 44, 2014 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-25361851

RESUMEN

BACKGROUND: Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). METHODS: 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. RESULTS: The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r=-0.61, p<0.001). The transit time from peak opacification of the right ventricle to first appearance in the left ventricle moderately correlated with PVR (r=0.46, p<0.01). Previously described echocardiographic methods for the determination of CO (Huntsman method) and PVR (Abbas and Haddad methods) did not correlate with RHC-determined values (p = 0.20 for CO, p = 0.18 and p = 0.22 for PVR, respectively). The contrast transit time method demonstrated reliable intra- (p<0.0001) and inter-observer correlation (p<0.001). CONCLUSIONS: We describe a novel method for the quantification of CO and estimation of PVR using contrast echocardiography transit time. This technique adds to the methodologies used for noninvasive hemodynamic assessment, but requires further validation to determine overall applicability.


Asunto(s)
Gasto Cardíaco , Ecocardiografía/métodos , Ventrículos Cardíacos/fisiopatología , Modelos Cardiovasculares , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Rigidez Vascular , Algoritmos , Cateterismo Cardíaco , Simulación por Computador , Medios de Contraste , Femenino , Fluorocarburos , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
3.
Echocardiography ; 31(4): 442-8, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24199601

RESUMEN

BACKGROUND: Pulmonary hypertension (PH) in patients with systemic hypertension and preserved ejection fraction (PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH. METHODS: Echocardiograms and records of hypertensive patients with left ventricular (LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures. RESULTS: Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate (eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm(2) , P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e' 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e' showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively). CONCLUSIONS: Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro-BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy.


Asunto(s)
Insuficiencia Cardíaca Diastólica/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Volumen Sistólico/fisiología , Resistencia Vascular/fisiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Ecocardiografía/métodos , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca Diastólica/complicaciones , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/diagnóstico por imagen , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no Paramétricas , Factores de Tiempo
4.
Sci Rep ; 14(1): 11762, 2024 05 23.
Artículo en Inglés | MEDLINE | ID: mdl-38783030

RESUMEN

There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.


Asunto(s)
Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Femenino , Masculino , Anciano , Estenosis de la Válvula Aórtica/cirugía , Anciano de 80 o más Años , Disparidades en Atención de Salud , Pacientes Internos/estadística & datos numéricos , Implantación de Prótesis de Válvulas Cardíacas , Estados Unidos/epidemiología , Mortalidad Hospitalaria , Persona de Mediana Edad , Factores Socioeconómicos , Clase Social , Válvula Aórtica/cirugía , Resultado del Tratamiento , Disparidades Socioeconómicas en Salud
5.
Sci Rep ; 14(1): 14394, 2024 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-38909141

RESUMEN

Individuals affected by human immunodeficiency virus (HIV) have a growing demand for coronary artery bypass grafting (CABG) due to heightened risk for cardiovascular diseases and extended life expectancy. However, CABG outcomes in HIV patients are not well-established, with insights only from small case series studies. This study conducted a comprehensive, population-based examination of in-hospital CABG outcomes in HIV patients. Patients underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Patients with age < 18 years and concomitant procedures were excluded. A 1:5 propensity-score matching was used to address preoperative group differences. Among patients who underwent CABG, 613 (0.36%) had HIV and were matched to 3119 out of 167,569 non-HIV patients. For selected HIV patients, CABG is relatively safe, presenting largely similar outcomes. After matching, HIV and non-HIV patients had comparable in-hospital mortality rates (2.13% vs. 1.67%, p = 0.40). Risk factors associated with mortality among HIV patients included previous CABG (aOR = 14.32, p = 0.01), chronic pulmonary disease (aOR = 8.24, p < 0.01), advanced renal failure (aOR = 7.49, p = 0.01), and peripheral vascular disease (aOR = 6.92, p = 0.01), which can be used for preoperative risk stratification. While HIV patients had higher acute kidney injury (AKI; 26.77% vs. 21.77%, p = 0.01) and infection (8.21% vs. 4.18%, p < 0.01), other complications were comparable between the groups.


Asunto(s)
Puente de Arteria Coronaria , Infecciones por VIH , Mortalidad Hospitalaria , Humanos , Puente de Arteria Coronaria/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Infecciones por VIH/epidemiología , Infecciones por VIH/cirugía , Anciano , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Resultado del Tratamiento , Adulto , Estados Unidos/epidemiología , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/mortalidad
6.
Artículo en Inglés | MEDLINE | ID: mdl-38052718

RESUMEN

BACKGROUND: Racial disparities in aortic valve replacement outcomes have been established. However, the current literature lacks comprehensive studies that examine the outcomes for Native Americans, probably due to their limited population size. This study aimed to investigate whether disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) also exist for outcomes among Native Americans. METHODS: Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015 to 2020. A 1:5 propensity score matching was conducted between Native Americans and Caucasians. In-hospital perioperative outcomes, length of stay, wait from admission to operation, and total hospital charge, were compared. RESULTS: In TAVR, 51,394 (84.41 %) were Caucasians and 171 (0.28 %) were Native Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 279 (0.44 %) Native Americans. After propensity matching, no significant difference was found in post-TAVR outcomes between Native Americans and Caucasians. However, Native Americans have a higher risk of neurological complications (2.88 % vs 0.79 %, p < 0.01) with stroke being the primary contributor (2.52 % vs 0.5 %, p < 0.01), as well as a higher incidence of venous thromboembolism (1.8 % vs 0.57 %, p < 0.05) after SAVR. CONCLUSIONS: This study is the first to examine aortic valve replacement outcomes in Native Americans. Native Americans were found to be more likely to undergo SAVR than TAVR. Moreover, Native Americans were found to have five times higher stroke and three times higher VTE after SAVR. These disparities faced by Native Americans underscore the need for increased attention and targeted actions to guarantee health equity.

7.
JAMA ; 318(14): 1395, 2017 10 10.
Artículo en Inglés | MEDLINE | ID: mdl-29049579
8.
Front Cardiovasc Med ; 9: 839400, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35387447

RESUMEN

Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice.

9.
Artículo en Inglés | MEDLINE | ID: mdl-33746507

RESUMEN

PURPOSE OF REVIEW: Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices. RECENT FINDINGS: In cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journals have established major presences in the social media space as an avenue to present novel, high-quality, peer-reviewed content to new audiences. SUMMARY: This review paper aims to introduce basic concepts in social media and cardiovascular imaging while highlighting recent topics of high importance, influence, and attention in cardiovascular imaging to include the ISCHEMIA trial, COVID-19, structural imaging, and multimodality advances from throughout 2020.

10.
Inquiry ; 57: 46958020971237, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33174501

RESUMEN

Participation in the Medicare Quality Payment Program's Merit Based Incentive Payment System (MIPS) has forced many healthcare administrators to strategize how to achieve success under value-based payment systems. A financial model was constructed to determine the marginal utility of compliance with various MIPS measures. Solo, small, medium, large, and very large practices were modeled using available data and final rules published by the United States Department of Health and Human Services (HHS). The model analysis found that small groups were generally incentivized not to comply with MIPS measures. Conversely, larger organizations were found to have strong financial incentives to maximize pursuit of MIPS measures. Incentives to pursue interoperability investments were projected to be generally under $10 200 for small organizations but approximately $690 000 for very large practices whereas the health information technology (IT) resources necessary to pursue these measures may not have nearly the same range of costs. In light of these findings, small groups may be driven to join larger groups as large groups continue to capitalize on their larger incentives to pursue MIPS measures. As financial success under MIPS is dependent on scale, healthcare systems that pursue consolidation may achieve greater success under quality payment programs similar to MIPS which include the newly proposed MIPS Value Pathways (MVPs).


Asunto(s)
Informática Médica , Motivación , Anciano , Humanos , Medicare , Reembolso de Incentivo , Asignación de Recursos , Estados Unidos
12.
JMIR Mhealth Uhealth ; 7(4): e10755, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31012860

RESUMEN

BACKGROUND: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease. OBJECTIVE: This study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling. METHODS: In total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian-30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. RESULTS: Enrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ≥9) increased significantly over time (P<.001)-from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups. CONCLUSIONS: Both traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling. TRIAL REGISTRATION: ClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426.


Asunto(s)
Enfermedades Cardiovasculares/dietoterapia , Consejo/normas , Dietoterapia/instrumentación , Aplicaciones Móviles/normas , Enfermedades Cardiovasculares/psicología , Consejo/métodos , Dietoterapia/métodos , Dietoterapia/normas , Dieta Mediterránea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/tendencias , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Proyectos Piloto , Factores de Riesgo
13.
Am J Cardiol ; 122(7): 1255-1259, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-30075895

RESUMEN

The demographics of authors in manuscript publications have been investigated in many specialties but not yet cardiology. We explored the authorship trends in The American Journal of Cardiology, a fundamental journal in this field, to uncover the historical demographic patterns in the field. Manuscripts published in 1958 (the first year of publication), 1966, 1976, 1986, 1996, 2006, and 2016 were analyzed. Parameters used were gender of first and last authors, number of authors per article, the authors' qualifications and country of corresponding authors. A total of 4,329 articles were analyzed. We hypothesized an increase in authors per article, variety of authors' degrees, countries contributing to authorship, and an increase in female authorship over time. We found that the mean number of authors per article increased from 1.8 in 1958 to 8.6 in 2016. Qualification varieties of first and last authors also increased, particularly first and last authors holding degrees in MD/PhD and first authors holding masters degrees. Female first and last authorship showed an increase. In 1958, female first authors comprised of 3.0% of all the publications compared with 23% in 2016. Similarly, female last authors accounted for 5.2% of all publications in 1958 compared with 20% in 2016. There was also an increase in articles originating from Europe and Asia. In conclusion, there has been a significant increase in authors per article, variety of author degrees, and contribution from international authors. Despite the relative lack of increase in female cardiologists compared to physicians in other specialties in the United States, female authors in The American Journal of Cardiology have increased significantly over this 58-year time period, surpassing the 13% overall female representation within this specialty.


Asunto(s)
Autoria , Cardiología , Publicaciones Periódicas como Asunto , Edición/tendencias , Bibliometría , Humanos , Estados Unidos
14.
Endocrinol Metab Clin North Am ; 36(2): 365-77, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17543724

RESUMEN

Coronary artery disease (CAD) mortality differs in men and women, leading to the speculation that differences in sex steroids contribute to risk. Controlled clinical trials have shown that estrogen replacement is not cardioprotective in certain women, and recent cross-sectional studies associate low testosterone with a greater incidence of CAD in men. Testosterone has demonstrated effects on insulin resistance, obesity, myocardium, coagulation, inflammation, vasodilation, and endothelial function. Imbalance of sex steroids contributes to adverse cardiac effects in men.


Asunto(s)
Enfermedad de la Arteria Coronaria/etiología , Hormonas Esteroides Gonadales/fisiología , Coagulación Sanguínea/fisiología , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/patología , Endotelio Vascular/fisiología , Endotelio Vascular/fisiopatología , Hormonas Esteroides Gonadales/sangre , Humanos , Hipogonadismo/metabolismo , Inflamación/complicaciones , Masculino , Miocardio/patología , Obesidad/sangre , Obesidad/complicaciones , Testosterona/sangre , Testosterona/farmacología , Trombosis/sangre , Trombosis/etiología
15.
Clin Cardiol ; 40(9): 648-653, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28444996

RESUMEN

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Hallazgos Incidentales , Mamografía , Calcificación Vascular/diagnóstico por imagen , Adulto , Anciano , Enfermedades Asintomáticas , Enfermedad de la Arteria Coronaria/epidemiología , Femenino , Humanos , Mamografía/normas , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Calcificación Vascular/epidemiología
16.
Clin Lab Med ; 26(3): 655-78, vii, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16938589

RESUMEN

Our recent understanding of acute coronary syndrome as an atherothrombotic process has led to research efforts in the development of markers of thrombosis and fibrinolysis for risk prediction in cardiovascular heart disease. Although American Heart Association/American College of Cardiology guidelines recommend fibrinogen as a category I risk factor and also suggest factor VII, plasminogen activator inhibitor-1, tissue-type plasminogen activator, and von Willebrand factor as other potentially clinically useful markers, these tests have not come into routine clinical use. Their development as predictors of risk may be hampered by inconsistent laboratory methodology, which causes difficulty in comparing result interpretation with published trial studies. This article presents the history of development for these tests, proper laboratory handling, the best trial data that present evidence of their accuracy, and current guidelines for clinical use.


Asunto(s)
Fibrinólisis/fisiología , Trombosis/diagnóstico , Trombosis/fisiopatología , Biomarcadores , Humanos , Estándares de Referencia , Manejo de Especímenes
17.
Mt Sinai J Med ; 73(4): 690-701, 2006 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16878275

RESUMEN

Despite considerable progress in the development of new therapies to control atherosclerosis and its complications, coronary heart disease (CHD) remains the number one cause of death in the Western world. While low high-density lipoprotein (HDL) has been associated with increased risk for CHD, raising HDL to reduce risk of disease has yet to be accepted as a standard therapeutic strategy. Currently available drugs that raise HDL (e.g., nicotinic acid, fibric acid derivatives, peroxisome proliferator-activated receptor agonists, and statins) also affect low-density lipoprotein (LDL) and other lipid constituents, making independent interpretation of their HDL-raising effect difficult to tease apart. Nevertheless, basic science studies suggest that HDL has multiple beneficial effects, and current efforts to develop new pharmacologic products with potent HDL-elevating effects may herald a day when HDL elevation becomes part of standard management of atherosclerotic diseases.


Asunto(s)
HDL-Colesterol/metabolismo , Enfermedad de la Arteria Coronaria/fisiopatología , Hiperlipidemias/fisiopatología , HDL-Colesterol/efectos de los fármacos , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Humanos , Hipolipemiantes/uso terapéutico , Medición de Riesgo , Factores de Riesgo
18.
Am J Med ; 129(1): 59-63, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26169886

RESUMEN

BACKGROUND: Industry manufacturers are required by the Sunshine Act to disclose payments to physicians. These data recently became publicly available, but some manufacturers prereleased their data since 2009. We tested the hypotheses that there would be discrepancies between manufacturers' and physicians' disclosures. METHODS: The financial disclosures by authors of all 39 American College of Cardiology and American Heart Association guidelines between 2009 and 2012 were matched to the public disclosures of 15 pharmaceutical companies during that same period. Duplicate authors across guidelines were assessed independently. Per the guidelines, payments <$10,000 are modest and ≥$10,000 are significant. Agreement was determined using a κ statistic; Fisher's exact and Mann-Whitney tests were used to detect statistical significance. RESULTS: The overall agreement between author and company disclosure was poor (κ = 0.238). There was a significant difference in error rates of disclosure among companies and authors (P = .019). Of disclosures by authors, companies failed to match them with an error rate of 71.6%. Of disclosures by companies, authors failed to match them with an error rate of 54.7%. CONCLUSIONS: Our analysis shows a concerning level of disagreement between guideline authors' and pharmaceutical companies' disclosures. Without ability for physicians to challenge reports, it is unclear whether these discrepancies reflect undisclosed relationships with industry or errors in reporting, and caution should be advised in interpretation of data from the Sunshine Act.


Asunto(s)
Autoria , Conflicto de Intereses , Revelación , Industria Farmacéutica/ética , Médicos/ética , Revelación/legislación & jurisprudencia , Industria Farmacéutica/legislación & jurisprudencia , Guías como Asunto , Humanos , Estados Unidos
20.
J Cardiovasc Transl Res ; 7(8): 701-10, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25245465

RESUMEN

Cardiovascular disease (CVD) is the leading cause of mortality worldwide and also exerts a significant economic burden, especially in low- and middle-income countries (LMICs). Detection of subclinical CVD, before an individual experiences a major event, may therefore offer the potential to prevent or delay morbidity and mortality, if combined with an appropriate care response. In this review, we discuss imaging technologies that can be used to detect subclinical atherosclerotic CVD (carotid ultrasound, coronary artery calcification) and nonatherosclerotic CVD (echocardiography). We review these imaging modalities, including aspects such as rationale, relevance, feasibility, utilization, and access in LMICs. The potential gains in detecting subclinical CVD may be substantial in LMICs, if earlier detection leads to earlier engagement with the health care system to prevent or delay cardiac events, morbidity, and premature mortality. Thus, dedicated studies examining the feasibility, utility, and cost-effectiveness of detecting subclinical CVD in LMICs are warranted.


Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Países en Desarrollo , Diagnóstico por Imagen/métodos , Pobreza , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Países en Desarrollo/economía , Diagnóstico por Imagen/economía , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/economía , Humanos , Valor Predictivo de las Pruebas , Pronóstico
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