RESUMEN
PURPOSE: Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models. METHODS: Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size. RESULTS: Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030). CONCLUSION: CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis. KEY POINTS: ⢠Pulmonary hypertension is a marker of poor outcome in COPD. ⢠MRI can predict invasively measured mean pulmonary artery pressure. ⢠Cardiac MRI allows for estimation of survival in COPD. ⢠Cardiac MRI may be useful for follow up or future trials. ⢠MRI is potentially useful to assess pulmonary hypertension in patients with COPD.
Asunto(s)
Ventrículos Cardíacos/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Arteria Pulmonar/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Función Ventricular Derecha/fisiología , Anciano , Cateterismo Cardíaco/métodos , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatologíaRESUMEN
As cloning technologies become more widely established, will products enter the food chain sooner than regulatory agencies and the public might be prepared for?
Asunto(s)
Animales Domésticos , Clonación de Organismos/economía , Clonación de Organismos/tendencias , Industria de Alimentos/economía , Industria de Alimentos/tendencias , Alimentos Modificados Genéticamente/economía , Organismos Modificados Genéticamente , Animales , Regulación Gubernamental , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Tampons have been associated with toxic shock syndrome, a newly-recognized disease which attacks women of menstrual age and has caused at least 84 deaths so far. A study of the medical literature since 1933, when tampons were first put on the market, reveals warning of possible dangers as a foreign body, as an irritant, as a carrier of bacteria. Today more health professionals are aware of the dangers of tampon use, but they have not yet applied this knowledge to diseases other than TSS. We believe this should be done. Tampons, now considered a Class II Medical Device, should be re-classified into Class III, where pre-market testing is mandatory.