The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging.

BACKGROUND: The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise. The purpose of this study is to determine the interaction of obesity and exercise ability on survival among patients with a normal stress-rest single-photon emission computed tomography (SPECT). METHODS: A total of 5,203 (60 ± 13 years, male 37%) patients without a history of heart disease and a normal stress-rest SPECT between the years 1995 and 2010 were included in this analysis. Body mass index categories were defined according to the World Health Organization classification: normal weight, 18.5 to 24.9 kg/m(2); overweight, 25 to 29.9 kg/m(2); and obese, ≥30 kg/m(2). Patients were divided into 3 groups based on their ability to exercise: those who reached ≥6 METs on exercise, those who attained a level of <6 METs, and those who required pharmacologic stress. Patients in each of these fitness groups were further divided into 3 subgroups based on their body mass index. RESULTS: There were 939 (18%) deaths during a mean follow-up of 8.1 ± 4.1 years, for an overall event rate of 2.3%/y. Both exercise to ≥6 METs and being obese were associated with lower mortality. Adjusted multivariate analysis using the obese high-fit patients as the reference showed a wide heterogeneity in annualized mortality rates according to exercise and weight status, with annualized event rates which varied from 0.6%/y in the obese subjects who were physically fit to 5.3%/y among healthy subjects who underwent pharmacologic stress testing (P < .001). CONCLUSIONS: Stress mode and body weight impacted long-term survival in patients with a normal stress SPECT. The benefit of being physically fit was evident in all weight groups, as was the adverse effect of being unable to exercise. However, with regard to body weight, there was a paradoxical survival advantage for those patients who were overweight and obese, regardless of their exercise ability.

Intermittent Recovery of Severe Acute Aortic Regurgitation Arising From Infective Endocarditis.

This case reports a 47-year-old male with a history of IV drug abuse, presenting with one week of left lower back pain. During the initial treatment, the patient became hemodynamically unstable, requiring vasopressor support. Transthoracic echocardiography (TTE) revealed a 1 cm x 1 cm aortic valve vegetation with severe aortic regurgitation and potential perforation of the valve leaflet. After hemodynamic stability was achieved, the patient left against medical advice, refusing urgent valvular surgery. Subsequent follow-up unveiled repeated recurrence of symptoms and surgical repair of the aortic valve.

Diagonal Earlobe Crease, a Marker of Coronary Artery Disease: A Case Report on Frank's Sign.

There are various physical signs that can be used as a reliable tool to diagnose the subclinical stages of atherosclerosis, including corneal arcus, xanthelasma, and diagonal earlobe crease (DELC) or "Frank's sign". Bilateral diagonal earlobe crease has been positively correlated with coronary artery disease (CAD) and peripheral vascular disease (PVD). The presence of DELC has been identified as an independent variable for CAD. The exact etiology is unknown and the association between the presence of DELC and coronary artery disease (CAD) still remains controversial. We report a case of a patient with bilateral DELC who was found to have remarkable non-occlusive CAD on diagnostic coronary angiography.

Stress-Induced Cardiomyopathy: As a Diagnosis That Is Time Sensitive and Anticipative in Certain Individuals.

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, presents as an acute coronary syndrome. However, the physiology and pathogenesis are different. It is imperative to treat stress-induced cardiomyopathy as an acute coronary syndrome, and once diagnosed, it is imperative to assess and treat heart failure and wait for the impaired myocardial energetics to resolve. At times, the myocardial recuperation is quick that we miss the diagnosis of Takotsubo cardiomyopathy.

The Effect of Transdermal Estrogen Patch Use on Cardiovascular Outcomes: A Systematic Review.

BACKGROUND: Vasomotor symptoms are the most commonly reported menopausal symptoms. Hormone therapy has been widely used to relieve postmenopausal symptoms. With studies suggesting an increased risk of cardiovascular events and breast cancer with oral hormone therapy use, there has been reluctance to use it. The transdermal estrogen patch provides relief from menopausal symptoms. However, there are limited data on mortality and cardiovascular outcomes, while on the transdermal estrogen patch. METHODS: An extensive search in Cochrane and PubMed databases was conducted up to February 2016. The selection criteria included healthy, peri-, and postmenopausal women between the ages of 50 and 79 and should have received transdermal estrogen therapy. The relationship between estrogen patch use and cardiovascular outcomes was analyzed. Six articles met the criteria and were included. RESULTS: We found some evidence suggestive of protective cardiovascular effects with transdermal estrogen therapy with a decrease in the risk of stroke and no increase in the risk of coronary heart disease, death, or myocardial infarction. DISCUSSION: This is one of the first systematic reviews addressing the association of transdermal estrogen patch use on cardiovascular outcomes. We found some evidence suggestive of a possible protective cardiovascular effect with transdermal estrogen therapy. Further randomized controlled studies are needed with a longer duration of follow-up, to study the cardiovascular effects of transdermal estrogen patches.

Myopericarditis and Pericardial Effusion as the Initial Presentation of Systemic Lupus Erythematosus.

Myopericarditis with a pericardial effusion as the initial presenting feature of SLE is uncommon. We report an unusual case of myopericarditis and pericardial effusion with subsequent heart failure, as the initial manifestation of SLE. The timely recognition and early steroid administration are imperative in SLE-related myopericarditis with cardiomyopathy to prevent the mortality associated with this condition.