Hepatic steatosis in patients with schizophrenia: a clinical cross-sectional study.

OBJECTIVE: With hepatic steatosis (HS) being an established risk factor for CVD in the general population, it may also be a predictor of CVD in patients with schizophrenia. The aim of the present study was to investigate if time since schizophrenia diagnosis, body mass index (BMI), sex, metabolic syndrome, alcohol use, smoking, alanine transaminase (ALT), and body fat percentage (as measured by bioelectrical impedance) were associated with HS, determined by computed tomography (CT), in a population of patients diagnosed with schizophrenia. METHODS: Moderate to severe HS (40 CT Hounsfield units as threshold) was determined utilizing non-contrast enhanced CT. The association between the explanatory variables and outcome of HS was assessed using multivariable logistic regression. RESULTS: In the present study, 145 patients diagnosed with schizophrenia (mean age 42.2 years (SD ± 13.8)) were included, with 88 (60.7%) being male. On average, patients had been diagnosed for 14.8 (SD ± 10.7) years. A total of 31 (21.4%) patients had HS as determined by CT. The presence of HS was associated with ALT (OR 1.06, 95% CI (1.02-1.10) per 1 U/L increase), and the presence of metabolic syndrome (OR 62.89, 95% CI (2.03-1949.55)). The presence of HS was not associated with BMI, body fat percentage or time since diagnosis in the multivariable analysis. CONCLUSION: Higher ALT and the presence of metabolic syndrome were associated with HS in patients with schizophrenia utilizing multivariable analysis. The findings suggest that risk factors for HS are similar in both the general population and in patients with schizophrenia.

Chronic total coronary occlusion: treatment results.

OBJECTIVES: To describe the clinical and procedural coronary chronic total occlusion (CTO) treatment results in a Nordic PCI centre during the implementation of a CTO treatment program. DESIGN: In a retrospective registry study, we assessed; (1) indication for the procedure, (2) Canadian Cardiovascular Society angina pectoris score (CCS)/New York Heart Association (NYHA) heart failure score, (3) lesion complexity and (4) adverse events during hospital stay and three months following the index procedure. RESULTS: The study cohort included 503 patients (594 lesions). From 2010 to 2013 96% of procedures were performed with antegrade wire-escalation technique and 4% performed using retrograde techniques, from 2013-2016 the corresponding numbers were 83% and 17.0%. The procedural success rate was 69%, increasing from 64% before to 72% (p = .06) after routinely using the retrograde approach. No individual patient characteristic, lesion variable or score was strongly associated with procedural success or failure. There were 4% serious procedure related complications. In patients with PCI of a CTO lesion only, 87% were in CCS or NYHA functional class ≥2 before the index procedure vs. 22% at follow-up. CONCLUSIONS: Routine use of retrograde techniques tended to increase the procedural success rate. Clinical results after three months were acceptable, but the complication rate was higher than for non-CTO PCI. Individual patient and lesion characteristics had a low predictability for procedural success. Therefore, clinical symptoms, objective signs of myocardial ischemia and procedural risk should be focus points in coronary chronic total occlusion treatment strategies.

Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy.

BACKGROUND AND STUDY AIMS: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. PATIENTS AND METHODS: Patients receiving gastroscopy within 12 months of PCI were identified and two nested case-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without adverse cardiac events and hemostatic intervention, respectively. Medical records were reviewed to obtain information on exposure to DAPT. RESULTS: We identified 22 654 PCI patients of whom 1497 patients (6.6 %) underwent gastroscopy. Twenty-two patients (1.5 %) suffered an adverse cardiac event, 93 patients (6.2 %) received hemostatic intervention during or within 30 days of the index gastroscopy. Interrupting DAPT was associated with a 3.46 times higher risk of adverse cardiac events (95 %CI 0.49 - 24.7). Discontinuation of one antiplatelet agent did not increase the risk (OR 0.65, 95 %CI 0.17 - 2.47). No hemostatic interventions were caused by endoscopic complications. CONCLUSION: Gastroscopy can be safely performed in PCI patients treated with DES and single antiplatelet therapy while interruption of DAPT may be associated with an increased risk of adverse cardiac events.

Safety and tolerability of regadenoson for myocardial perfusion imaging - first Danish experience.

OBJECTIVES: Evaluating safety and tolerability of the selective A2A receptor agonist, regadenoson, in patients referred for single photon emission computed tomography myocardial perfusion imaging (MPI). DESIGN: Observational study of patients referred for MPI stress testing using a 400 µg regadenoson (Rapiscan(®)) bolus. Hemodynamic variables and severity of adverse events (AE) were recorded before, during, and after administration. RESULTS: A total of 232 patients were included. One or more AE were reported in 90% of patients; the AEs were graded mostly mild to moderate in severity, resolved spontaneously, and were mainly dyspnea, headache, and chest pain. No advanced heart block or bronchospasm were seen. Transient ST-segment changes developed in 10 patients. The maximum increase in heart rate was 19 ± 11 beats/minute. The mean systolic blood pressure decreased from 144 to 139 mmHg (p < 0.0001). Medical intervention was required in three patients: one case with severe hypotension and two cases with chest pain that was relieved with sublingual nitroglycerin. One patient died the day after stress MPI for reasons considered unrelated to regadenoson. CONCLUSION: Regadenoson for MPI is easy to use with a high frequency of AEs, which are generally mild in severity, transient, and resolve spontaneously.