Clinical utility of 99mTc-labeled ubiquicidin 29-41 antimicrobial peptide for the scintigraphic detection of mediastinitis after cardiac surgery.

BACKGROUND: Previous studies demonstrated that (99m)Tc-labeled-ubiquicidin 29-41 ((99m)Tc-UBI 29-41) imaging is an accurate method for detection of bacterial infections. This study was conducted to evaluate the clinical use of (99m)Tc-UBI 29-41 for detection of mediastinitis after cardiac surgery. METHODS: Thirteen patients with suspected mediastinitis after cardiac surgery were included. Qualitative and semiquantitative analyses of (99m)Tc-UBI 29-41 images were performed. Mediastinitis was confirmed by bacterial culture. RESULTS: Qualitative analysis correctly identified the infection in 5/6 patients with mediastinitis. For observer 1, there were five true-positive results, six true-negative results, one false-positive result and one false-negative result (sensitivity: 83%, specificity: 85%, positive predictive value: 83%, negative predictive value: 85%, and overall diagnostic accuracy: 84%). For observer 2, there were five true-positive results, five true-negative results, two false-positive results and one false-negative result (sensitivity: 83%, specificity: 71%, positive predictive value: 71%, negative predictive value: 83%, and overall diagnostic accuracy: 76%). Agreement between observers was 0.847 (SE=0.145, p=0.002). Semiquantitative analysis showed a higher mediastinum uptake of the (99m)Tc-UBI 29-41 in patients with mediastinitis than that derived from patients without mediastinitis. Mean uptake of (99m)Tc-UBI 29-41 was 60.4+/-10.3 counts/pixel and 47.4+/-5.5 counts/pixel, respectively (p=0.01). At the threshold value of > or =57 counts/pixel using ROC analysis, the sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy for detecting patients with mediastinitis were 83, 100, 100, 87, and 92%, respectively (p=0.02; 95% CI: 0.65-1.10%). CONCLUSIONS: (99m)Tc-UBI 29-41 imaging yielded fast and promising first results for patients with suspected mediastinitis after cardiac surgery and, as such, deserves further investigation.

[Cardiac involvement in Kearns-Sayre syndrome]. / Afección cardíaca en el síndrome de Kearns-Sayre.

The mitochondrial cytopathies or oxidative-phosphorylation diseases are a diverse group of disorders that result from the structural, biochemical, or genetic derangement of mitochondria. Because mitochondrial dysfunction can affect the most highly energy-dependent organs, cardiac involvement is frequent in these diseases. To identify the clinical features of Kearns-Sayre syndrome, an entity associated with this group of diseases, we evaluated cardiac structure and function in 5 patients with Kearns-Sayre syndrome and followed the clinical course of these patients for 5 years.

Afección cardíaca en el síndrome de Kearns-Sayre / Cardiac involvement in Kearns-Sayre syndrome

Las citopatías mitocondriales o enfermedades de las fosforilación oxidativa constituyen un diverso grupo de enfermedades cuya etiología subyace en trastornos estructurales, bioquímicos o genéticos de la mitocondria. Dado que una disfunción mitocondrial afecta a los órganos con mayores requerimientos energéticos, la afección cardíaca es frecuente en estos trastornos. Con el fin de determinar las características clínicas de la involucración cardíaca en el síndrome de Kearns-Sayre, entidad asociada a este grupo de enfermedades, hemos estudiado la estructura y la función cardíacas en una serie de 5 casos que, además, han sido seguidos durante 5 años

The mitochondrial cytopathies or oxidative-phosphorylation diseases are a diverse group of disorders that result from the structural, biochemical, or genetic derangement of mitochondria. Because mitochondrial dysfunction can affect the most highly energy-dependent organs, cardiac involvement is frequent in these diseases. To identify the clinical features of Kearns-Sayre syndrome, an entity associated with this group of diseases, we evaluated cardiac structure and function in 5 patients with Kearns-Sayre syndrome and followed the clinical course of these patients for 5 years

Maintenance of exercise capacity and physical activity patterns 2 years after cardiac rehabilitation.

BACKGROUND: The benefits of exercise training for postmyocardial infarction and postcoronary artery bypass surgery patients are well established, but little is known about the effects of rehabilitation in the months or years following the program. The purpose of this study was to assess exercise capacity, blood lipids, and physical activity patterns 2 years after completing a concentrated residential rehabilitation program in Switzerland. METHODS: Seventy-eight patients (86% males, mean age = 56 +/- 10, mean ejection fraction = 64% +/- 12%) were referred to a residential rehabilitation program after a myocardial infarction or coronary artery bypass surgery between January 2001 and June 2001. Patients lived at the center for 1 month, during which time they underwent educational sessions, consumed a low-fat diet, and exercised 2 hours daily. Two years after completing the program, patients returned to the hospital and underwent a maximal exercise test, an assessment of recent and adulthood physical activity patterns, and evaluation of blood lipids. RESULTS: During the 2-year follow-up period, there were 5 deaths, and 70 of the remaining 73 patients returned for repeat testing. Mean exercise capacity increased 27% during the rehabilitation program (P < .01). Gains in exercise capacity during rehabilitation were maintained after the follow-up period; mean exercise capacity after 2 years was 34% higher compared with that at baseline (P < .01). At the 2-year evaluation, patients were expending a mean of 3127 +/- 1689 kcals/wk during recreational activities compared with 977 +/- 842 kcals/wk during adulthood prior to their cardiac event (P < .001). Between the completion of rehabilitation and the 2-year follow-up, total cholesterol, total cholesterol/high-density lipoprotein ratio, and triglycerides increased significantly. CONCLUSIONS: Two years after a cardiac event and participation in a concentrated residential rehabilitation program, patients maintained their exercise capacity and engaged in physical activities that exceed the levels recommended by guidelines for cardiovascular health. These observations suggest that a relatively intensive rehabilitation program provided a catalyst to maintain physical activity patterns and exercise tolerance in the 2 years following a cardiac event.

An evaluation of training responses using self-regulation in a residential rehabilitation program.

BACKGROUND: The efficacy of exercise training for patients with cardiovascular disease is well established. Given recent changes in reimbursement patterns for cardiac rehabilitation and therefore a greater need for self-monitoring, home programs, and the like, a need exists to determine the capability of patients to regulate their own exercise intensity and assess the efficacy of self-regulated exercise. This study assessed the training responses of a group instructed to train at an intensity they perceived as "somewhat hard," and compared their responses to standardized methods of exercise prescription. METHODS: A total of 78 patients (86% male; mean age, 56 +/- 10 years; mean ejection fraction, 64% +/- 12%) referred to a residential rehabilitation program after myocardial infarction or bypass surgery were randomized to three different groups, for which exercise intensity was prescribed using different methods. For group 1, 70% of heart rate reserve was maintained using precise, continuous electronic heart rate-controlled resistance on a cycle ergometer. Group 2 gauged their own exercise intensity according to a level they perceived as "somewhat hard" (13 on the Borg scale) and were given no feedback in terms of heart rate or work rate. For group 3, exercise intensity was determined using both objective (heart rate reserve and work rate targeted to 60% to 80% of maximal exercise) and subjective (Borg scale 12 to 14) indices. The subjects exercised daily for 1 month. Training frequency, duration, and mode were equivalent between the groups. RESULTS: The exercise capacity of the three groups was increased significantly after the training period: 33.7% in group 1, 22.9% in group 2, and 31.2% in group 3 (P <.005 for all). Other measures of the training response also were similar between the groups, including a significant increase in work rate at a perceived exertion of 13 and maximal watts achieved. The magnitude of the training response was not different between the groups. There were no complications during training. CONCLUSIONS: The training response was similar between the three methods used to monitor exercise intensity. Thus, patients are able to gauge their own exercise intensity reasonably when instructed to exercise at a perceived exertion of 13. This suggests that close heart rate monitoring may not always be necessary for many stable patients with cardiovascular disease to achieve the benefits of a rehabilitation program.