Does multi-parity affect the size of the ascending thoracic aorta in women: a prospective cohort study.

OBJECTIVE: Aortic dissection is an uncommon and potentially fatal complication of pregnancy; however, the association of the number of pregnancies with the indexed and absolute size of the ascending aorta in patients without aortic aneurysm or connective tissue disorders is not well elucidated. RESEARCH DESIGN AND METHODS: In this prospective observational study, women aged 18-80 years old undergoing transesophageal echocardiography in a university-affiliated echocardiography laboratory between 1 January 2015 and 1 September 2015 were enrolled. Indexed and absolute sizes of ascending aorta at the levels of annulus, root, sinotubular junction (STJ), proximal and arch were measured. Patients were grouped according to their gravida number into three classes (class I: ≤3, class II: 4-7, class III: ≥7). RESULTS: Of 653 screened patients, 437 women were included (38.9% gravida class I, 44.3% gravida class II and 16.7% gravida class III). In univariate analysis, the number of pregnancies correlated with indexed diameters of the root (p < .001), STJ (p < .001) and the proximal ascending aorta (p < .001). Meanwhile, the number of pregnancies neither correlated with the annular diameter nor with the arch (p = .070 and p = .154, respectively). In multivariate analyses, the gravida class was among the independent predictors of the root size along with age, aortic insufficiency and the presence of congestive heart failure. CONCLUSION: Gravida class was an independent predictor of aortic size at levels of the root, STJ and the proximal ascending aorta. The largest increase was observed at the level of the aortic root.

Fragmented QRS on surface electrocardiogram as a predictor of perfusion defect in patients with suspected coronary artery disease undergoing myocardial perfusion imaging.

BACKGROUND: Fragmented QRS (FQRS) on surface electrocardiogram (ECG) is associated with the presence of myocardial scar tissue and may have prognostic value after certain ischemic events. We aimed to examine the anatomical correlation of FQRS with the presence of perfusion abnormalities in patients with suspected coronary artery disease (CAD). METHODS: Patients without a known history of CAD, who were referred for myocardial perfusion imaging (MPI) between January 2016 and May 2016, were enrolled. The presence of FQRS on surface ECG was evaluated. The presence of FQRS, number of leads with FQRS, and the location of FQRS as well as patient characteristics were compared in patients with normal versus abnormal MPI. Multivariate model was constructed to identify independent factors associated with perfusion defect. RESULTS: One hundred four women and 94 men were enrolled. Fragmentation of anterior, lateral, and inferior leads was detected in 13 (6.5%), 17 (8.5%), and 36 (18.1%) subjects, respectively. MPI was normal in 134 (67.6%) patients. FQRS was significantly more common in patients with abnormal MPI (p < 0.001). Age (odds ratio [OR]: 1.05 [1.02-1.08]; p = 0.001), number of the leads presenting FQRS (OR: 1.46 [1.12-1.92] p = 0.006), and diabetes (OR: 2.33 [1.16-4.69]; p = 0.018) were independent predictors of the presence of perfusion defect on MPI. CONCLUSION: In the absence of known CAD, FQRS is associated with the presence of perfusion abnormalities. Incorporating FQRS in diagnostic armamentarium may aid us in selecting patients who may benefit from MPI.