Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers.

BACKGROUND: While adenosine and dipyridamole as myocardial perfusion imaging (MPI) stress agents have literature supporting their safety in the setting of myocardial infarction (MI), regadenoson does not. Studying a high risk cohort of patients with elevated cardiac biomarkers may shed light on potential safety issues of these agents which might also affect lower risk cohorts. METHODS: All patients who had undergone a clinically indicated stress MPI study at two academic centers from 1/1/2010 through 12/31/2012 with elevated troponin ≤7 days prior to testing were included. The primary endpoint was a composite of death, non-fatal MI, congestive heart failure (CHF), stroke, ventricular arrhythmias, atrial fibrillation/flutter, or atrioventricular block requiring intervention within 24 h of testing. RESULTS: Of the 703 stress MPI studies that met inclusion criteria, 360 (51.2%), 199 (28.3%), 74 (10.5%), 9 (1.3%), and 61 (8.7%) underwent regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively. The primary endpoint occurred in 11 (1.6%) patients with an incidence of 1.4% (n = 5), 1.0% (n = 2), 1.4% (n = 1), 11.1% (n = 1), and 3.3% (n = 2) following regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively (P = 0.137). The adverse events included non-fatal MI in 7 (1.0%) patients, death in 1 (0.1%) patient, CHF in 1 (0.1%) patient, ventricular arrhythmia in 1 (0.1%) patient, and atrial arrhythmia in 1 (0.1%) patient. CONCLUSION: In the setting of elevated troponin, serious complications associated with either exercise or vasodilator stress testing appear to be relatively rare with no increased risk attributable to a particular vasodilator agent.

Dermatofibrosarcoma Protuberans Of Trunk In A Male Patient.

Dermatofibrosarcoma protuberans is a rare cutaneous malignancy. Usual sites of origin are trunk and extremities. Aetiology of the condition is not well understood but a genetic basis is explained as a reciprocal translocation t (17l;22) (q22; q13). Distant metastasis is quite rare as it is mostly a locally advancing tumour. Histopathology is the most accurate investigation to make a diagnosis. Imaging is still required to rule out distant metastasis. Surgical excision is the treatment option for stage I tumours. Imatinib, a tyrosine kinase inhibitor, has shown promising results in management of locally advanced and metastatic disease.