RESUMO
Unfortunately, the 3rd author name was incorrectly published in the original publication. The complete correct name is given below.
RESUMO
BACKGROUND: Prior studies have reported ECG (Electrocardiogram) changes during tilt table testing (TTT), specifically during repolarization with ST-segment and T-wave changes. The correlation with ischemic evaluation remains unclear. The purpose of this study was to analyze the prevalence of ST-segment changes during TTT in a young, otherwise healthy population of patients with postural tachycardia syndrome (POTS), and correlate them with exercise stress test results. METHODS: Two hundred and fifty-five patients with POTS who underwent TTT and an exercise treadmill test (ETT) were analyzed. RESULTS: Forty-five had ST-segment changes/depressions during TTT (91% female, average age 36 years). Of the 45, three had ST-segment depression during ETT; all three had negative exercise stress echocardiograms (ESEs). Two others had ST-segment depressions on ETT (but not TTT), with negative ESEs. CONCLUSION: In a cohort of young, female, otherwise healthy patients with POTS, ST-segment changes occurred in a significant portion (18%) of patients during TTT. When evaluated with exercise stress testing, these patients had no evidence of underlying ischemia on ETT or ESE.
RESUMO
BACKGROUND: Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS: In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS: Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION: The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING: British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Adipócitos , Tecido Adiposo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/mortalidade , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida , Adulto JovemAssuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Lesões por Radiação/cirurgia , Neoplasias Torácicas/radioterapia , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/efeitos da radiação , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/mortalidade , Ecocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Lesões por Radiação/mortalidade , Recuperação de Função Fisiológica , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
Gated positron emission testing with computed tomography (PET-CT) yields left ventricular (LV) volume analysis along with perfusion analysis. The correlation between PET-CT volumes and cardiac magnetic resonance imaging (CMR) volumes remains unknown. Understanding of the accuracy of these volumes and ejection fractions (EF) by PET is clinically relevant, particularly in the sarcoid population where patients receive initial diagnostic CMR and then are followed by PET for inflammation. 89 patients undergoing cardiac sarcoidosis evaluation with both rest PET-CT and CMR within approximately 1 year were identified at Cleveland Clinic from 2011 to 2021. LV volumes and EF were collected. Linear regression and Bland-Altman analyses were performed. Mean PET-CT derived left ventricular ejection fraction (LVEF) was 46 ± 16% with mean LV end diastolic volume (LVEDV) of 127 ± 60â mL and mean LV end systolic volume (LVESV) of 75 ± 54â mL. Mean CMR-derived LVEF was 47 ± 15% with mean LVEDV of 189 ± 61â mL and mean LVESV of 106 ± 60â mL. Pearson correlation coefficient with standard measurements was 0.85 for EF, 0.80 for LVEDV, and 0.86 for LVESV. In our cohort, there is an excellent correlation of LVEF between PET-CT and CMR with a mean difference of 1.1% and a good correlation of volumes between these two imaging modalities. This has potential clinical implications when judging LVEF qualifications for medical and device therapies although future larger validation cohorts are warranted.
RESUMO
PURPOSE: Exercise intolerance is a hallmark of the postural orthostatic tachycardia syndrome (POTS). However, no data are available on the implications of an exaggerated submaximal heart rate (HR) on exercise intolerance in patients. We investigated whether exaggerated HR responses occurring early on during incremental stress testing relate with increased odds of POTS and exercise intolerance. METHODS: Clinical characteristics and stress test HRs were compared between adults with POTS achieving ≥85% predicted metabolic equivalents (METs) (EX-TL, n = 101; body mass index [BMI] 24 ± 5 kg·m; 95% women) or <85% (EX-INTL, n = 71; BMI 28 ± 7 kg·m; 79% women) and sedentary controls (n = 30; BMI 36 ± 3 kg·m; 87% women). Multivariate logistic regressions were performed to estimate ORs and the probability of POTS and exercise intolerance associated with exercise HRs. RESULTS: Exercise tolerance was increased in EX-TL, but not in EX-INTL (10.0 ± 1.3 and 8.3 ± 1.5 METs vs 8.0 ± 1.6 METs, respectively) versus controls. Absolute peak HR was increased in EX-TL and EX-INTL versus controls (P < .01), whereas percent predicted did not differ. Exercise within the first-to-second stress stages was performed at exaggerated HRs (122 ± 17 bpm vs 103 ± 15 and 113 ± 15 bpm, P < .001) and percent HR reserve in EX-INTL versus controls and EX-TL (49% ± 12% vs 34% ± 11% and 41% ± 11%, P < .001), respectively. In multivariate analyses, peak HR was not significant, whereas increased submaximal HR (either variable) was associated with increased odds of EX-TL or EX-INTL. Lastly, odds of EX-INTL increased as METs decreased, whereas METs was not a predictor of EX-TL. CONCLUSIONS: An exaggerated submaximal exercise HR is predictive of POTS and exercise intolerance, and this chronotropic phenotype is exacerbated in patients achieving <85% predicted METs.
Assuntos
Síndrome da Taquicardia Postural Ortostática , Pressão Sanguínea , Exercício Físico , Teste de Esforço , Tolerância ao Exercício , Feminino , Frequência Cardíaca , Humanos , MasculinoRESUMO
Although some suggest anti-Xa assays should be the preferred method for monitoring intravenous unfractionated heparin therapy, which method is best is unknown owing to the lack of large randomized controlled trials correlating different assays with clinical outcomes. This article provides an overview of heparin monitoring and the pros, cons, and clinical applications of anti-Xa assays.
Assuntos
Antifibrinolíticos/sangue , Testes de Coagulação Sanguínea/métodos , Monitoramento de Medicamentos/métodos , Fibrinolíticos/sangue , Heparina/sangue , Antifibrinolíticos/imunologia , Fator Xa/imunologia , Fibrinolíticos/imunologia , Fibrinolíticos/uso terapêutico , Heparina/imunologia , Heparina/uso terapêutico , HumanosRESUMO
In Aleyadeh W, Hutt-Centeno E, Ahmed HM, Shah NP. Hypertension guidelines: treat patients, not numbers. Cleve Clin J Med 2019; 86(1):47-56. doi:10.3949/ccjm.86a.18027, on page 50, the following statement was incorrect: "In 2017, the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) recommended a relaxed systolic blood pressure target, ie, below 150 mm Hg, for adults over age 60, but a tighter goal of less than 130 mm Hg for the same age group if they have transient ischemic attack, stroke, or high cardiovascular risk.9" In fact, the ACP and AAFP recommended a tighter goal of less than 140 mm Hg for this higher-risk group. This has been corrected online.
RESUMO
The updated 2017 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for managing hypertension advocate tighter blood pressure control than previous guidelines. This review summarizes the evidence behind the guidelines, discusses the risks and benefits of stricter blood pressure control, and provides our insights on blood pressure management in clinical practice.
Assuntos
Cardiologia , Hipertensão , Adulto , American Heart Association , Pressão Sanguínea , Humanos , Antígeno Nuclear de Célula em Proliferação , Estados UnidosAssuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Fludrocortisona/uso terapêutico , Midodrina/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Síncope Vasovagal/terapia , Adulto , Terapia Combinada , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Meias de Compressão , Teste da Mesa Inclinada , Resultado do TratamentoRESUMO
Los recientes avances en tecnologías biomédicas proporcionan herramientas a la Medicina Legal para el esclarecimiento de casos complejos y ejercer justicia basada en evidencia científica. ¿Pero qué ocurre cuando se imponen obstáculos como el quimerismo que podrían llevar a decisiones equivocadas? A pesar de que este fenómeno se creía casi inexistente, se han reportado interesantes casos, que han puesto a prueba la utilidad de las pruebas de ADN. El quimerismo se define como la presencia de líneas celulares con distinto material genético proveniente de diferentes orígenes en un único cuerpo. Esto tiene grandes implicaciones medico legales, principalmente en la investigación criminal. Por ejemplo en una escena de crimen, se pueden encontrar muestras de tejidos de un mismo individuo pero estas podrían tener ADN distinto si se trata de un individuo quimérico llevando a una mala interpretación de la información. También cabe resaltar las implicaciones del quimerismo en las pruebas de paternidad, ya que este fenómeno puede ocasionar falsos negativos en estas pruebas y por lo tanto un diagnóstico incierto de paternidad. El objetivo de esta revisión es describir las diferentes implicaciones médico legales del quimerismo y proponer posibles soluciones a los conflictos que podrían presentarse ante tales casos.
Recent advances in biomedical technologies are able to clarify todays complex cases that are faced by Legal Medicine; allowing this branch of medicine to exercise justice based in scientific evidence. But what happens when an obstacle such as chimerism is present and may lead to false decisions? Although this phenomenon was thought to be inexistent, interesting cases have been reported. Chimerism is defined as the presence of different cell linings in a unique organism. This phenomenon has important implication in Legal Medicine, especially in criminal investigation. For example, in a crime scene the samples gathered may present different DNA and lead to misinterpretation of the information. On the other hand, paternity tests are also implicated in the presence of a chimera since it may originate a false negative result. The purpose of this review is to describe different Legal Medicines implications linked to chimerism and propose possible solutions to the conflicts that may arouse from a case of a chimera.