Detection of silent coronary artery disease by computed tomographic scan: coronary artery calcium versus noninvasive coronary angiography.

OBJECTIVES: Multislice computerized tomographic scan can identify coronary artery disease (CAD) with quantification of coronary artery calcium (CAC) and computed tomographic coronary angiography (CTA). The utility of CAC in comparison with CTA in asymptomatic patients has not been assessed. METHODS: Patients with risk factors for CAD, who were referred for screening, were studied using CAC and CTA, using a Phillips Mx8000 IDT 16 multislice computed tomographic scanner. RESULTS: Three hundred and forty-seven patients with a mean age of 55 years, 89.9% male, were included. CAC showed calcium deposits in 171 patients (49.3%) whereas CTA found lesions in 157 patients (45%). CAC correctly identified 309 patients with respect to CTA (presence of any disease) implying a test accuracy of 89%, sensitivity of 85%, specificity of 86%, and negative predictive value of 93%. Obstructive lesions were shown by 7.7% of the patients (stenosis >50%), 22% of the patients with CAC greater than 400, and 2.8% of the patients with CAC of 0. To undergo a CTA scan after CAC permits to re-classify 11% of the patients on the basis of CTA. CONCLUSION: CAC, in detecting silent CAD, seems to be a good alternative to CTA, in these asymptomatic patients, but CAC is inappropriate to predict the presence or absence of a coronary artery obstruction.

Long-term implications of a single home-based educational intervention in patients with heart failure.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure. METHODS: There were 106 patients: 42 in the intervention group and 64 in the control group. Patients were randomly assigned to receive an intervention by nursing staff 1 week after discharge. Primary end points were readmissions, emergency department visits, deaths, costs, and quality of life. RESULTS: During the 24-month follow-up, there were fewer mean emergency department visits in the intervention group than in the control group (.68 vs 2.00; P = .000), fewer unplanned readmissions (.68 vs 1.71; P = .000), and lower costs (€ 671.56 = $974.63 = GBP598.42 per person vs € 2,154.24 = $3,126.01 = GBP1,919.64; P = .001). There was a trend toward fewer out-of-hospital deaths (14 [46.6%] vs 31 [55.3%]; P = .45) and improvement in quality of life. CONCLUSION: Patients with heart failure who receive a home-based educational intervention experience fewer emergency department visits and unplanned readmissions with lower healthcare costs.

[Clinical study of 28 patients with cerebellar hemorrhage]. / Hemorragias de cerebelo: estudio de 28 pacientes.

BACKGROUND AND OBJECTIVE: To characterize the clinical features, etiology and prognosis of cerebellar hemorrhage. PATIENTS AND METHODS: Descriptive study of 28 patients with cerebellar hemorrhages included in the Sagrat Cor Hospital of Barcelona Stroke Registry over a 19 year period. The vascular risk factors and clinical profiles in the subcortical hemorrhage group (n=133) were compared. RESULTS: Cerebellar hemorrhages accounted for 0.73% of all acute strokes (n=3,808) and 6,9% of all intracerebral hemorrhages. Hypertension was present in 60,7%, atrial fibrillation in 17,9% and ischemic heart disease in 10,4%. The overall in-hospital mortality rate was 21,4%. Ataxia (OR=91,75; 95% CI, 14,90-564,98), nausea and vomiting (OR=12,85; 95% CI, 2,80-58,93) and sensory symptoms (OR=0.05; 95% CI, 0,01-0,36) were independent clinical predictors related to cerebellar hemorrhage. CONCLUSIONS: Cerebellar hemorrhage is uncommon. In-hospital mortality is 21.4% and clinical profiles were different in cerebellar hemorrhages when compared to subcortical hemorrhages.