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2.
Open Heart ; 6(1): e000981, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217997

RESUMO

Objective: High aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored. Methods: Aortic stiffness was assessed as carotid-femoral pulse wave velocity (PWV) by applanation tonometry in 125 patients (62±8 years, 58% women) with stable angina and non-obstructive CAD participating in the Myocardial Ischemia in Non-obstructive CAD project. PWV in the highest tertile (>8.7 m/s) was taken as higher aortic stiffness. Stress-induced myocardial ischaemia was detected as delayed myocardial contrast replenishment during stress echocardiography, and the number of left ventricular (LV) segments with delayed contrast replenishment as the extent of ischaemia. Results: Patients with higher aortic stiffness were older with higher LV mass index and lower prevalence of obesity (all p<0.05), while angina symptoms, sex, prevalence of hypertension, diabetes, smoking or LV ejection fraction did not differ between groups. Stress-induced myocardial ischaemia was more common (73% vs 42%, p=0.001) and the extent of ischaemia was larger (4±3 vs 2±3 LV segments, p=0.005) in patients with higher aortic stiffness. In multivariable logistic regression analysis, higher aortic stiffness was associated with stress-induced myocardial ischaemia independent of other known covariables (OR 4.74 (95% CI 1.51 to 14.93), p=0.008). Conclusions: In patients with stable angina and non-obstructive CAD, higher aortic stiffness was associated with stress-induced myocardial ischaemia. Consequently, assessment of aortic stiffness may add to the diagnostic evaluation in patients with non-obstructive CAD. Trial registration number: NCT01853527.

3.
Int J Cardiol ; 286: 1-6, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30952529

RESUMO

BACKGROUND: The underlying mechanisms causing myocardial ischemia in non-obstructive coronary artery disease (CAD) are still unclear. We explored whether left ventricular hypertrophy (LVH) was associated with myocardial ischemia in patients with stable angina and non-obstructive CAD. METHODS: 132 patients (mean age 63 ±â€¯8 years, 56% women) with stable angina and non-obstructive CAD diagnosed as <50% stenosis by coronary computed tomography angiography (CCTA) underwent myocardial contrast stress echocardiography. Left ventricular (LV) hypertrophy (LVH) was identified by LV mass index >46.7 g/m2.7 in women and >49.2 g/m2.7 in men. Patients were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. The number of LV segments with ischemia at peak stress was taken as a measure of the extent of myocardial ischemia. RESULTS: Myocardial ischemia was found in 52% of patients, with on average 5 ±â€¯3 ischemic LV segments per patient. The group with myocardial ischemia had higher prevalence of LVH (23 vs. 10%, p = 0.035), while age, sex and prevalence of hypertension did not differ between groups (all p > 0.05). In multivariable regression analyses, LVH was associated with presence of myocardial ischemia (odds ratio 3.27, 95% confidence interval [1.11-9.60], p = 0.031), and larger extent of myocardial ischemia (ß = 0.22, p = 0.012), independent of confounders including age, hypertension, obesity, hypercholesterolemia, calcium score and segment involvement score by CCTA. CONCLUSIONS: LVH was independently associated with both presence and extent of myocardial ischemia in patients with stable angina and non-obstructive CAD by CCTA. These results suggest LVH as an independent contributor to myocardial ischemia in non-obstructive CAD. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, identifier NCT018535271.


Assuntos
Doença da Artéria Coronariana/complicações , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Isquemia Miocárdica/etiologia , Função Ventricular Esquerda/fisiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Estudos Transversais , Ecocardiografia sob Estresse , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Noruega/epidemiologia , Estudos Retrospectivos
4.
Tidsskr Nor Laegeforen ; 139(3)2019 02 12.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30754951

RESUMO

BAKGRUNN: I 2002 ble Forskerlinjen opprettet for tidlig å rekruttere medisinstudenter til forskning. Vi ønsket å kartlegge hvor mange tidligere forskerlinjestudenter fra Universitetet i Bergen som fortsatte å forske og identifisere faktorer som var assosiert med videre forskning. MATERIALE OG METODE: Alle studenter innrullert i forskerlinjeprogrammet ved Universitetet i Bergen siden oppstart i 2002 som var uteksaminert fra medisinstudiet innen juni 2017 ble kontaktet per e-post med en elektronisk spørreundersøkelse. Vi undersøkte om deltagerne holdt på med eller hadde gjennomført doktorgrad, antall publiserte artikler, tid siden siste publisering, akademisk undervisning og veiledning samt nåværende stilling på universitet eller høyskole. RESULTATER: Totalt 102 av 148 (69 %) besvarte spørreundersøkelsen. Av disse hadde 68 % gått videre med doktorgrad, 38 % var involvert i akademisk undervisning eller veiledning og 29 % var ansatt i en akademisk stilling. Samlet hadde deltagerne i median publisert fire artikler. Kvinner hadde større sannsynlighet for å gå videre med doktorgrad enn menn. Det samme hadde de som publiserte minst én artikkel før fullført medisinstudium, og de som ikke hadde mottatt regelmessig veiledning som forskerlinjestudent. Det var ingen sammenheng mellom det å fullføre Forskerlinjen og det å gå videre med doktorgrad. FORTOLKNING: Mange medisinstudenter som har gått Forskerlinjen ved Universitetet i Bergen fortsetter med forskning etter fullført studium. Dette gjelder også de som ikke fullfører linjen.


Assuntos
Pesquisa Biomédica/educação , Educação Médica , Pesquisadores/estatística & dados numéricos , Dissertações Acadêmicas como Assunto , Adulto , Escolha da Profissão , Educação de Pós-Graduação/estatística & dados numéricos , Docentes de Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Noruega , Publicações/estatística & dados numéricos , Distribuição por Sexo , Estudantes de Medicina , Inquéritos e Questionários , Ensino/estatística & dados numéricos
6.
J Womens Health (Larchmt) ; 24(5): 367-73, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25692527

RESUMO

BACKGROUND: Women with non-ST elevation myocardial infarction (NSTEMI) have similar extent of myocardial ischemia but less obstructive coronary artery disease (CAD) than their male counterparts. We tested the impact of global coronary artery plaque area and artery tortuosity on myocardial perfusion in NSTEMI patients. METHODS: Coronary artery plaque area was determined by quantitative angiography in 108 patients (32% women) with NSTEMI. Myocardial perfusion was assessed by contrast echocardiography in the 17 individual left ventricular segments. Artery tortuosity was defined as ≥3 curves >45° in a main coronary artery. RESULTS: Age, prevalence of hypertension, and diabetes did not differ between sexes (all nonsignificant). Women had lower prevalence of ≥50% coronary artery stenosis (74% vs. 91%, p<0.05), while global coronary plaque area (35±22 vs. 43±21mm(2)) and the number of segments with hypoperfusion (6.9±3.7 vs. 7.2±3.4) did not differ between sexes (both p>0.07). In multivariate analysis, larger coronary artery plaque area was associated with a 35% higher risk for having severe myocardial hypoperfusion (odds ratio 1.35 [95% confidence interval 1.01-1.80], p<0.05) in the total study population, while no association between artery tortuosity and myocardial ischemia was found. Similar results were obtained in separate analysis among women and men. CONCLUSION: In women and men with NSTEMI, the global coronary artery plaque area was an important determinant of the severity of myocardial hypoperfusion at rest independent of presence of significant coronary stenoses. These findings may expand current understanding of NSTEMI in patients with nonobstructive CAD.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Infarto do Miocárdio/complicações , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Medição de Risco , Distribuição por Sexo
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