Frequency and Severity of Temporomandibular Disorders Among Weightlifters at Fitness Centers in a Subset Population of Saudi Arabia: A Cross-Sectional Observational Study.

Background Teeth clenching in weightlifters is a common finding that may result in temporomandibular disorders (TMDs). This study aimed to evaluate the severity and frequency of TMDs among weightlifters at fitness centers in Saudi Arabia. Methods A cross-sectional study was designed to collect data from weightlifters at fitness centers. A non-probability convenient sampling technique was applied using a valid and reliable Fonseca's questionnaire on a Google Sheet (Google, Mountain View, CA) to collect participant data. The survey was conducted from November 2022 to April 2023. Epi Info software (CDC, Atlanta, Georgia) was used to calculate the sample size, and a minimum sample of 278 was required. The data underwent analysis using SPSS version 20 (IBM Corp., Armonk, NY). Results Data analyzed from 375 participants revealed that 192 (51.2%) had mild signs of TMD, whereas 128 (34.13%) of the respondents had no symptoms of TMD. A significant difference was observed among female participants in all the temporomandibular joint severity categories. A statistically significant difference was observed between both genders concerning frequent headaches, earache, and nervousness. Conclusion The prevalence of TMD is high worldwide. Unsupervised athletic activity may result in the occurrence of TMD. Fonseca's questionnaire findings reveal a mild prevalence of TMD in weightlifters.

Acute unilateral maculopathy after hand, foot and mouth disease.

Unilateral acute maculopathy is a rare inflammatory macular disorder believed to be caused by viral infection, especially Coxsackievirus. It most commonly affects young healthy adults. This is a case report of unilateral acute maculopathy in a 28-year-old man with concurrent hand, foot and mouth disease. Although the typical acute manifestation of the disease is sudden, severe, unilateral central vision loss, most patients achieve full visual recovery over the course of several weeks without therapy.

Audit of clinical follow-up and complications after acute pulmonary embolism in an Australian Metropolitan Health Service.

We explored post-pulmonary embolism (post-PE) follow-up at a large Australian regional city hospital health service. Over a 12-month period, we identified 195 (49% male) patients with a median age of 62 years. Post-PE follow-up was not organised for 23 patients and delayed for seven patients. Post-PE complication occurred in 21% of all patients reviewed in the clinic after discharge. Follow-up imaging was arranged in 28% of patients. To deliver high-quality care, we recommend implementing a local post-PE follow-up pathway, which balances individual physician preference with available resources and expert recommendations.

Study of level of the precautionary measures taken by parents and the impact of COVID 2019 on children daily life during curfew.

Background: COVID-19 has caused many changes in all communities world-wildly, at many levels, leaving us to reset our priorities and needs. All that for the sake of surviving this pandemic. But children played the least important role in these rearrangements, or at least this how the community handled it. Aim of the study: To study the precautionary measures that were taken by the parents on their children in the kingdom of Saudi Arabia during curfew. Study the impact of COVID on children's healthcare, diet, and daily routines. Methods: A community-based cross-sectional study was conducted in different regions of Saudi Arabia from the period of 1st July 2020 to 30th January 2021. Data were compiled and analyzed using a statistical package for the social sciences (SPSS, version 16) and results were analyzed with frequencies and Chi-squared test as appropriate. P-value was considered significant if P < 0.05. Results: The study included 532 participants, 69.7% of participated parents were mothers (females) and 30.3% were fathers (males). 83.5% of mothers were highly educated. 41% didn't observe any change in their children's activity, the little less 37% agreed that it decreased their activity. 64.5% of the parents believed that herbal meds and supplements boost their children's immunity. 27.6% were not sure. The rest 7.9% didn't believe in their effect. 39% of the parents who had children in the age of vaccination, had to delay it, while 60% stuck to the schedule. Conclusion: People sticking to precautionary measures were more relatable to what they believed not what they were forced to do the increased number of cases at the beginning of the partial curfew proves that. Even though social gathering had its financial penalty the responses were greater with hand washing.

Effect of Vasodilatory Medications on Blood Pressure in Patients Undergoing Transradial Coronary Angiography: A Comparative Study.

BACKGROUND: In patients undergoing coronary intervention, different vasodilators are used to prevent the radial artery spasm (RAS). To date, no studies investigated the effect of these vasodilators in blood pressure (BP) reduction. AIM: The study aimed to investigate and compare the effect of vasodilatory medications on BP reduction in patients undergoing transradial coronary angiography procedure. METHODS: We consecutively included 300 patients undergoing transradial coronary angiography procedures and randomly assigned them into three equal groups to compare the effect of verapamil (2.5 mg), nitroglycerin (200 µg), and combination (verapamil 2.5 mg with nitroglycerin 200 (µg) was diluted in 5 ml of normal saline and given through radial sheath. Changes in the BP, heart rate (HR), and other clinical parameters were assessed and presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). ANOVA test was performed to analyze the differences in the BP and other clinical parameters between the three groups. RESULTS: Overall, the mean age of the study population was 53.26 years (standard deviation: 9.27), male patients (84%), with dyslipidemia (62.6%), and diabetes (45%). At baseline, the mean systolic BP (SBP) was 150.91 ± 31.66 mmHg, HR (72.34 ± 12.71 beats/min). After the administration of vasodilators, the combination group reduced SBP significantly (SMD: -33.35 [95% CI]: -40.27--26.42, P < 0.001). There was a statistically significant difference between groups for the SBP (F [2,296] =3.38, P = 0.035). Verapamil alone showed a significant decrease in the SBP by -27.23 mmHg and diastolic BP by -4.980 mmHg. CONCLUSION: Intra-arterial administration of verapamil alone showed lower BP reduction compared to the combination of vasodilators. Verapamil could be a safer and effective alternative to prevent RAS with no deleterious effect on BP and HR in patients undergoing transradial coronary angiography.

Impact of Resident-Paired Schedule on Medical Student Education and Impression of Residency Programs.

INTRODUCTION: Clinical rotations in emergency medicine (EM) can be challenging for medical students because of the lack of continuity with attending physicians. To overcome this challenge, institutions have started to match a student's schedule with that of a resident, referred to as "paired shifts." We sought to pilot and compare two schedule formats for fourth-year medical students (MS4) - a resident-paired shifts (RPS) and a traditional resident-unpaired shifts (RUS) schedule. METHODS: This prospective, crossover trial included MS4s rotating in the emergency department over four consecutive four-week blocks. Each MS4 was assigned two weeks using the RUS schedule and two weeks with the RPS schedule, alternating the format order each month. At the end of the rotation students were anonymously surveyed regarding the differences in learning experience, their ability to showcase their knowledge and clinical skills, and familiarity with the residency program with the two formats. RESULTS: The response rate was 47 of 58 students (84%). Respondents indicated that RPS resulted in more teaching time (64.6% RPS vs 8.3% RUS), a better overall educational experience (68.8% RPS vs 8.3% RUS), and a greater ability to showcase their medical knowledge (52.1% RPS vs 6.3% RUS). Additionally, students felt that the program was better able to evaluate them (66.7% RPS vs 10.4% RUS) and they were better able to better evaluate the program (66.7% RPS vs 6.3% RUS) in the RPS format. CONCLUSIONS: When compared to traditional RUS during an MS4 rotation, a RPS format provided students with the perception of an improved learning experience, ability to showcase knowledge, and familiarity with the residency program without sacrificing teaching from attending physicians.

Left ventricular global longitudinal strain predicts mortality and heart failure admissions in African American patients.

BACKGROUND: Several studies have demonstrated the importance of left ventricular (LV) global longitudinal strain (GLS) as a reliable prognostic indicator in patients with heart failure (HF). These studies have included few African American (AA) patients, despite the growing prevalence and severity of HF in this patient population. HYPOTHESIS: LV GLS predicts long-term HF admission and all-cause mortality in AA patients with chronic HF on optimal guideline-directed medical therapy (GDMT). METHODS: We enrolled 207 AA adults, age 56 ± 14.5 years, with New York Heart Association (NYHA) class I through III HF on optimal GDMT from the University of Illinois HF clinic between November 2001 and February 2014. LV GLS was assessed by velocity vector imaging using 2-, 3-, and 4-chamber views. Patients were followed for HF admissions and death for 3 ± 3.0 years. LV GLS value of -7.95 was used as the optimal cutoff point that maximizes sensitivity and specificity RESULTS: LV GLS < -7.95% was significantly associated with higher all-cause mortality and HF admissions in Kaplan-Meier survival curves (log-rank P < 0.001). After incorporation in multivariate Cox proportional hazard models, GLS < -7.95% was found to be an independent predictor of all-cause mortality (hazard ratio [HR] = 4.04; 95% confidence interval [CI]: 1.07-15.32; P = 0.04] and HF admissions (HR = 3.86; 95% CI: 1.38-10.77; P = 0.010). CONCLUSIONS: In AA patients with chronic stable HF on GDMT, more impaired LV GLS (< -7.95%) is a strong and independent predictor of long-term all-cause mortality and HF admissions.

Left Ventricular global longitudinal strain predicts heart failure readmission in acute decompensated heart failure.

BACKGROUND: The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. METHODS AND RESULTS: Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis. CONCLUSION: LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.

Circulating Procollagen Type III N-Terminal Peptide and Mortality Risk in African Americans With Heart Failure.

BACKGROUND: Procollagen type III N-terminal peptide (PIIINP) is a biomarker of cardiac fibrosis that is associated with heart failure prognosis in whites. Its prognostic significance in African Americans is unknown. We sought to determine whether PIIINP is associated with outcomes in African Americans with heart failure. METHODS AND RESULTS: Blood was collected from 138 African Americans with heart failure for determining PIIINP and genetic ancestry, and patients were followed prospectively for death or hospitalization for heart failure. PIIINP was inversely correlated with West African ancestry (R(2) = 0.061; P = .010). PIIINP > 4.88 ng/mL was associated with all-cause mortality on univariate (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.2-11.0; P < .001) and multivariate (HR 5.8; 95% CI 1.9-17.3; P = .002) analyses over a median follow-up period of 3 years. We also observed an increased risk for the combined outcome of all-cause mortality or hospitalization for heart failure with PIIINP > 4.88 ng/mL on univariate (HR 2.6, 95% CI 1.6-5.0; P < .001) and multivariate (HR 2.4, 95% CI 1.2-4.7; P = .016) analyses. CONCLUSIONS: High circulating PIIINP is associated with poor outcomes in African Americans with chronic heart failure, suggesting that PIIINP may be useful in identifying African Americans who may benefit from additional therapy to combat fibrosis as a means of improving prognosis.

Antihyperglycemic effect of thymoquinone and oleuropein, on streptozotocin-induced diabetes mellitus in experimental animals.

BACKGROUND: Diabetes mellitus is one of the most important diseases related with endocrines. Its main manifestation includes abnormal metabolism of carbohydrates and lipids and inappropriate hyperglycemia that is caused by absolute or relative insulin deficiency. It affects humankind worldwide. OBJECTIVES: Our research was aimed to observe antihyperglycemic activity of thymoquinone and oleuropein. MATERIALS AND METHODS: In this study, rats were divided into six groups, 6 rats in each. Diabetes was inducted by streptozotocin (STZ). The level of fasting blood glucose was determined for each rats during the experiment, doses of thymoquinone and oleuropein (3 mg/kg and 5 mg/kg) for both, were injected intraperitoneal. Pancreatic tissues were investigated to compare ß-cells in diabetic and treated rats. RESULT AND CONCLUSION: It was found that thymoquinone and oleuropein significantly decrease serum Glucose levels in STZ induced diabetic rats.

Hepatic histological alterations and biochemical changes induced by sildenafil overdoses.

Sildenafil is used for the treatment of erectile dysfunction and is helping millions of men around the world to achieve and maintain a long lasting erection. Fifty healthy male rabbits (Oryctolagus cuniculus) were used in the present study and exposed daily to sildenafil (0, 1, 3, 6, 9 mg/kg) for 5 days per week for 7 weeks to investigate the biochemical changes and alterations in the hepatic tissues induced by this drug overdosing. In comparison with respective control rabbits, sildenafil overdoses elevated significantly (p-value<0.05, ANOVA test) alanine aminotransferase (ALT), aspartate aminotransferase (AST), testosterone, follicular stimulating hormone and total protein, while creatinine and urea were lowered with no significant alteration was observed in uric acid and luteinizing hormone concentration. Also sildenafil provoked hepatocytes nuclear alterations, necrosis, hydropic degeneration, bile duct hyperplasia, Kupffer cells hyperplasia, inflammatory cells infiltration, hepatic vessels congestion and evident partial depletion of glycogen content. The results show that subchronic exposure to sildenafil overdoses exhibits significant biochemical and alterations in the hepatic tissues that might affect the functions of the liver and other vital organs.

Association of aldosterone synthase polymorphism (CYP11B2 -344T>C) and genetic ancestry with atrial fibrillation and serum aldosterone in African Americans with heart failure.

The objective of this study was to examine the extent to which aldosterone synthase genotype (CYP11B2) and genetic ancestry correlate with atrial fibrillation (AF) and serum aldosterone in African Americans with heart failure. Clinical data, echocardiographic measurements, and a genetic sample for determination of CYP11B2 -344T>C (rs1799998) genotype and genetic ancestry were collected from 194 self-reported African Americans with chronic, ambulatory heart failure. Genetic ancestry was determined using 105 autosomal ancestry informative markers. In a sub-set of patients (n = 126), serum was also collected for determination of circulating aldosterone. The CYP11B2 -344C allele frequency was 18% among the study population, and 19% of patients had AF. Multiple logistic regression revealed that the CYP11B2 -344CC genotype was a significant independent predictor of AF (OR 12.7, 95% CI 1.60-98.4, p = 0.0150, empirical p = 0.011) while holding multiple clinical factors, left atrial size, and percent European ancestry constant. Serum aldosterone was significantly higher among patients with AF (p = 0.036), whereas increased West African ancestry was inversely correlated with serum aldosterone (r = -0.19, p = 0.037). The CYP11B2 -344CC genotype was also overrepresented among patients with extreme aldosterone elevation (≥90th percentile, p = 0.0145). In this cohort of African Americans with chronic ambulatory heart failure, the CYP11B2 -344T>C genotype was a significant independent predictor of AF while holding clinical, echocardiographic predictors, and genetic ancestry constant. In addition, increased West African ancestry was associated with decreased serum aldosterone levels, potentially providing an explanation for the lower risk for AF observed among African Americans.

Comparison of the updated 2011 appropriate use criteria for echocardiography to the original criteria for transthoracic, transesophageal, and stress echocardiography.

BACKGROUND: The aim of this study was to compare appropriateness designations as determined by the updated 2011 appropriate use criteria (AUC) for echocardiography with prior versions of the AUC for transthoracic echocardiographic (TTE) imaging, transesophageal echocardiographic (TEE) imaging, and stress echocardiographic (SE) imaging. An additional goal was to define relationships between appropriateness determinations and echocardiographic findings for each modality. METHODS: Previously published data sets of TTE, TEE, and SE studies were reclassified according to the 2011 AUC, and indication representation, appropriateness designations, and echocardiographic findings were compared with prior classifications according to the 2007 AUC for TTE and TEE imaging and the 2008 AUC for SE imaging. RESULTS: Overall, 2,247 echocardiographic studies were analyzed. The 2011 AUC addressed the vast majority of studies (98%), a marked increase compared with prior versions of the AUC (89%) (P < .001). An increase in addressed studies was present in each echocardiographic modality (TTE imaging: n = 1,525, 98% vs 89%, P < .001; TEE imaging: n = 405, 99.7% vs 91%, P < .01; SE imaging: n = 289, 97% vs 88%, P < .01). Among all echocardiographic procedures, the 2011 AUC found a lower frequency of appropriate studies compared with prior AUC (82% vs 88%, P < .01), primarily because of new uncertain indications for TTE imaging. The frequency of inappropriate echocardiographic studies was unchanged (11%). Among all echocardiographic procedures, the 2011 AUC found appropriate studies to have more new abnormal echocardiographic findings compared with inappropriate studies (45% vs 13%, P < .001). Interestingly, 2011 AUC inappropriate TTE studies had fewer major new echocardiographic abnormalities than 2007 AUC inappropriate TTE studies (9% vs 17%, P = .04). CONCLUSIONS: The updated 2011 AUC for echocardiography encompass the vast majority of echocardiographic procedures in a university hospital practice, filling virtually all of the gaps identified in prior versions of the AUC for TTE, TEE, and SE imaging. The 2011 AUC also reasonably stratify the likelihood of finding an echocardiographic abnormality, demonstrating improvement compared with the prior AUC.

Use of a web-based application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Use Criteria for Transthoracic Echocardiography: a pilot study.

BACKGROUND: Clinical application of the American College of Cardiology Foundation Appropriate Use Criteria (AUC) represents a potentially feasible alternative to third-party pre-certification for imaging procedures and will soon be required as part of the accreditation process for imaging laboratories. Electronic tools that rapidly apply the AUC are needed in clinical practice. We developed and tested a web-based application of the AUC to track appropriateness of transthoracic echocardiography (TTE). METHODS: Indications for outpatient TTE studies performed in a university hospital echocardiography laboratory were assessed prospectively at the point of service using a prototype web-based AUC application (Echo AUC App). The Echo AUC App was developed on the basis of our own prior published data regarding indication frequency to minimize time and screens required for completion. Echo AUC App-determined indications were compared with blinded investigator-determined indications based on review of relevant medical records. Echo AUC App characteristics, including Echo AUC App entry time, were recorded. RESULTS: Of the 258 studies enrolled, Echo AUC App-determined TTE indications were Appropriate (A) in 77% (n = 198), Inappropriate (I) in 9% (n = 23), and Not Classified (NC) by the AUC in 14% (n = 37). Agreement between Echo AUC App- and investigator-determined classifications was excellent (94%, kappa statistic 0.83). Mean Echo AUC App study entry time was 55 seconds (range 25-280 seconds). CONCLUSION: The use of an electronic application allows rapid and accurate implementation of the AUC for TTE at the point of service. Such an application could be installed in echocardiography laboratories to track appropriateness in accordance with soon-to-be-implemented accreditation requirements. Further study of this Echo AUC App at the point of order may provide an alternative to third-party pre-certification procedures.

Evaluation of the clinical application of the ACCF/ASE appropriateness criteria for stress echocardiography.

BACKGROUND: The aim of this study was to evaluate the clinical application of the American College of Cardiology Foundation and American Society of Echocardiography appropriateness criteria for stress echocardiography (SE) in a single-center university hospital. METHODS: Indications were determined for consecutive studies by two reviewers and categorized as appropriate, uncertain, or inappropriate. RESULTS: Of 477 studies for which primary indications could be determined, 188 specifically related to university transplantation programs were excluded. Of the remaining 289 studies, 88% were addressed in the appropriateness criteria for SE. Of these, 71% were appropriate, 9% were uncertain, and 20% were inappropriate. Inappropriate studies were more likely to be ordered on younger patients and women and were less likely to be ordered by cardiologists. Abnormal results on SE were more frequent among appropriate than inappropriate studies. CONCLUSIONS: The appropriateness criteria for SE encompass and effectively characterize the majority of studies ordered in a single-center university hospital and appear to reasonably stratify the likelihood of abnormal results on SE. However, revisions will be required to fully capture and stratify appropriate clinical practice of SE.

Carbohydrate antigen 125 predicts long-term mortality in African American patients with acute decompensated heart failure.

The goal of this study was to evaluate the relation between serum levels of carbohydrate antigen 125 (CA125) and prognosis in African American (AA) patients with heart failure (HF). Little is known about the usefulness of CA125 in the AA population, which has different pathophysiology and higher prevalence of HF. The authors enrolled 172 consecutive AA patients (mean age, 55.8 years; 61.1% men) admitted with a clinical diagnosis of acute decompensated HF. CA125 was measured within 48+/-12 hours of presentation. Patients were grouped according to CA125 levels into quartiles. The median CA125 level was 16 U/mL. Serum levels of CA125 were elevated (>35 U/mL) in 58 patients (33.7%). Fifty-two patients (30.8%) died over a median follow-up period of 40 months. The CA125 threshold derived from the receiver operating characteristic curves for the prediction of mortality was 35 U/mL. In a multivariate analysis, CA125 levels >35 U/mL were found to be predictive of 40-month all-cause mortality (adjusted hazard ratio, 2.53; confidence interval, 1.40-4.59; P=.002). However, CA125 levels were not associated with 18-month HF rehospitalization. CA125 value is a strong and independent predictor of long-term mortality in AA patients admitted with a diagnosis of acute decompensated HF. Identifying a higher-risk cohort might allow for a more targeted treatment approach.

Comparison of the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for outpatient transthoracic echocardiography in academic and community practice settings.

BACKGROUND: We sought to compare the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for outpatient transthoracic echocardiography (TTE) in academic and community practice settings. METHODS: Indications for TTE ordered in both academic and community practice settings were determined by 2 reviewers and categorized according to the AC for TTE as Appropriate, Inappropriate, or Not Addressed. Patient characteristics, ordering physician specialty, and TTE findings were also recorded. RESULTS: Overall, 814 academic and 319 community TTEs were analyzed. Interobserver variability for indication determination was high and did not differ between studies ordered at the 2 practice settings. Compared with the academic practice, community practice TTE indications were more likely to be classified in the AC for TTE (88% vs 82%, P = .04), but were ordered for a similar frequency of Appropriate (71% vs 68%, P = not significant) and Inappropriate (17% vs 15%, P = not significant) indications. New important TTE abnormalities were more frequently found in Appropriate studies compared with Inappropriate studies in both academic (35% vs 16%, P < .001) and community practice (29% vs 15%, P = .04) settings. CONCLUSION: The clinical application of the AC for TTE is feasible, and the frequency of Appropriate and Inappropriate outpatient TTEs is similar in academic and community practice settings. However, limitations of the AC for TTE are identified that suggest revisions will be needed to fully encompass and stratify the broad clinical practice of echocardiography.

Evaluation of the application of the ACCF/ASE appropriateness criteria for transesophageal echocardiography in an academic medical center.

BACKGROUND: The aim of this study was to prospectively evaluate the clinical application of the recently published American College of Cardiology Foundation and American Society of Echocardiography appropriateness criteria (AC) for transesophageal echocardiographic (TEE) imaging at a single-center university hospital. METHODS: As outlined in the AC, TEE studies were divided into those performed subsequent to transthoracic echocardiographic imaging (adjunctive TEE studies) and those that were the initial echocardiographic studies for the indications being evaluated (initial TEE studies). Each study was categorized as appropriate, uncertain, or inappropriate, according to the relevant section of the AC, and the study's impact on patient management was determined. RESULTS: Of the 405 studies enrolled, 27% were adjunctive and 73% were initial. Ninety-one percent of TEE studies could be classified by the AC. Overall, 97% of the studies were appropriate, 1% were inappropriate, and 2% were uncertain. Patient management was affected by 94% of appropriate studies but by only 50% of uncertain or inappropriate studies. CONCLUSIONS: The AC for TEE imaging can be feasibly applied and encompass the majority of the clinical practice of transesophageal echocardiography in an academic setting.

Six minute walk test predicts long-term all-cause mortality and heart failure rehospitalization in African-American patients hospitalized with acute decompensated heart failure.

BACKGROUND: The prognostic value of the 6-minute walk test (6MWT) has been described in patients with heart failure (HF); however, limited data are available in an African-American (AA) population. We prospectively evaluated the usefulness of the 6MWT in predicting mortality and HF rehospitalization in AA patients with acute decompensated HF. METHODS AND RESULTS: Two hundred AA patients (63.1% men, mean age 55.7 +/- 12.9 years) with acute decompensated HF were prospectively studied. Patients were followed to assess 40-month all-cause mortality and 18-month HF rehospitalization. The median distance walked on the 6MWT was 213 m. Of the 198 patients with available mortality data, 59 patients (29.8%) died. Of the 191 patients with available rehospitalization data, 114 (59.7%) were rehospitalized for worsening HF. For patients who walked 200 m (P = .001). For patients who walked 200 m (P = .027). Multivariate Cox regression analysis showed that 6MWT distance

Prospective evaluation of the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for transthoracic echocardiography.

We sought to prospectively evaluate the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for transthoracic echocardiography in a single-center university hospital. Indications for transthoracic echocardiograms (TTE) were prospectively determined for consecutive studies by 2 reviewers and categorized, according to the AC for TTE, as appropriate (A) or inappropriate (I). The overall level of agreement in characterizing appropriateness between reviewers was high (kappa = 0.83). Among the 1,553 studies for which a primary indication was determined, 89% were covered in the AC for TTE. Of these studies, 89% were A, and 11% were I. New important TTE abnormalities were more common on A compared with I studies (40% vs. 17%, p < 0.001), and noncardiac specialists more frequently ordered I studies (13% vs. 9%, p = 0.04). In conclusion, the AC for TTE encompasses the majority of clinical indications for TTE and appears to reasonably stratify TTE ordering. However, revisions will be needed to fully capture and stratify appropriate clinical practice.