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https://www.readbyqxmd.com/read/28320636/the-significance-of-equivocal-exercise-treadmill-ecg-for-intermediate-risk-chest-pain-assessment-insight-from-coronary-ct-angiography-data
#1
Gary T E Lau, Henry Wei, Jo Wickham, Andrew C Y To
BACKGROUND: Exercise treadmill test (ETT) is commonly the first-line investigation in troponin-negative chest pain patients. Inconclusive results are common and often lead to repeated functional testings. Coronary computed tomographic angiography (CCTA) has excellent negative predictive value for coronary artery disease detection and may play an important role in their diagnostic workup. We aim to analyse ETT and CCTA findings to understand their modern roles in intermediate risk chest pain population with inconclusive ETT...
March 1, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28292858/predictive-value-of-age-and-sex-specific-nomograms-of-global-plaque-burden-on-coronary-computed-tomography-angiography-for-major-cardiac-events
#2
Christopher Naoum, Daniel S Berman, Amir Ahmadi, Philipp Blanke, Heidi Gransar, Jagat Narula, Leslee J Shaw, Leonard Kritharides, Stephan Achenbach, Mouaz H Al-Mallah, Daniele Andreini, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Benjamin Chow, Ricardo C Cury, Augustin DeLago, Allison Dunning, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A Kaufmann, Yong-Jin Kim, Erica Maffei, Hugo Marquez, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Todd C Villines, James Min, Jonathon Leipsic
BACKGROUND: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. METHODS AND RESULTS: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years)...
March 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28292380/correlation-of-c-reactive-protein-and-cardiac-enzymes-with-angiographic-severity-of-coronary-artery-disease-in-pakistani-patients-with-acute-coronary-syndrome
#3
Ayesha Saleem, Azmat Ali
OBJECTIVE: To determine the correlation of C-reactive protein (CRP) levels with the severity of coronary stenosis on angiography and the association of cardiac enzymes with the degree of stenosis in acute coronary syndrome (ACS) patients. Secondly, to compare association of angiographic severity of vascular stenosis with CRP in patients with ST segment elevation myocardial infarction (STEMI) and non-STEMI / Unstable angina (UA). STUDY DESIGN: Prospective, descriptive study...
February 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28288007/clinical-utility-of-the-heart-score-in-patients-admitted-with-chest-pain-to-an-inner-city-hospital-in-the-usa
#4
Soumya Patnaik, Mahek Shah, Yaser Alhamshari, Pradhum Ram, Ritika Puri, Marvin Lu, Percy Balderia, John B Imms, Obiora Maludum, Vincent M Figueredo
BACKGROUND: Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. PATIENTS AND METHODS: We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia...
March 10, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28286825/screening-characteristics-of-timi-score-in-predicting-acute-coronary-syndrome-outcome-a-diagnostic-accuracy-study
#5
Mostafa Alavi-Moghaddam, Saeed Safari, Hamideh Alavi-Moghaddam
INTRODUCTION: In cases with potential diagnosis of ischemic chest pain, screening high risk patients for adverse outcomes would be very helpful. The present study was designed aiming to determine the diagnostic accuracy of thrombolysis in myocardial infarction (TIMI) score in Patients with potential diagnosis of ischemic chest pain. METHOD: This diagnostic accuracy study was designed to evaluate the screening performance characteristics of TIMI score in predicting 30-day outcomes of mortality, myocardial infarction (MI), and need for revascularization in patients presenting to ED with complaint of typical chest pain and diagnosis of unstable angina or Non-ST elevation MI...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28261896/identifying-low-risk-patients-for-early-discharge-from-emergency-department-without-using-subjective-descriptions-of-chest-pain-insights-from-providing-rapid-out-of-hospital-acute-cardiovascular-treatment-proact-3-and-4-trials
#6
Nariman Sepehrvand, Yinggan Zheng, Paul W Armstrong, Robert C Welsh, Justin A Ezekowitz
BACKGROUND: Several accelerated diagnostic protocols (ADP) have been developed to allow emergency department (ED) physicians to identify appropriate patients for safe early discharge after presentation with symptom of chest pain. Most ADPs require chest pain to be described and modify the algorithm based on the subjective chest pain characteristics. We investigated the performance of 3 established major ADPs simplified by eliminating the need for chest pain as a descriptor. METHODS: We pooled patients from PROACT-3 and 4 trials, in which patients presenting to emergency medical services (EMS) with chest pain or dyspnea were enrolled...
March 6, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28230045/the-single-chest-tube-versus-double-chest-tube-application-after-pulmonary-lobectomy-a-systematic-review-and-meta-analysis
#7
REVIEW
Xuefei Zhang, Desheng Lv, Mo Li, Ge Sun, Changhong Liu
OBJECTIVE: Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. The objective of this study was to evaluate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. PATIENTS AND METHODS: We performed a meta-analysis of five randomized studies that compared the single chest tube with double chest tube application after pulmonary lobectomy. The primary end-point was amount of drainage and duration of chest tube drainage...
December 2016: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28224927/an-age-and-sex-specific-gene-expression-score-is-associated-with-revascularization-and-coronary-artery-disease-insights-from-the-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain-promise-trial
#8
Deepak Voora, Adrian Coles, Kerry L Lee, Udo Hoffmann, James A Wingrove, Brian Rhees, Lin Huang, Susan E Daniels, Mark Monane, Steven Rosenberg, Svati H Shah, William E Kraus, Geoffrey S Ginsburg, Pamela S Douglas
BACKGROUND: Identifying predictors of coronary artery disease (CAD)-related procedures and events remains a priority. METHODS: We measured an age- and sex-specific gene expression score (ASGES) previously validated to detect obstructive CAD (oCAD) in symptomatic nondiabetic patients in the PROMISE trial. The outcomes were oCAD (≥70% stenosis in ≥1 vessel or ≥50% left main stenosis on CT angiography [CTA]) and a composite endpoint of death, myocardial infarction, revascularization, or unstable angina...
February 2017: American Heart Journal
https://www.readbyqxmd.com/read/28205445/severe-hypertriglyceridemia-induced-by-sirolimus-treated-with-medical-management-without-plasmapheresis
#9
Kazuhiko Kido, Rickey A Evans, Anil Gopinath, Jeremy D Flynn
Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28167641/prognostic-utility-of-a-modified-heart-score-in-chest-pain-patients-in-the-emergency-department
#10
James McCord, Rafael Cabrera, Bertil Lindahl, Evangelos Giannitsis, Kaleigh Evans, Richard Nowak, Tiberio Frisoli, Richard Body, Michael Christ, Christopher R deFilippi, Robert H Christenson, Gordon Jacobsen, Aitor Alquezar, Mauro Panteghini, Dina Melki, Mario Plebani, Franck Verschuren, John French, Garnet Bendig, Silvia Weiser, Christian Mueller
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013...
February 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28166668/annals-express-association-between-plasma-proprotein-convertase-subtilisin-kexin-type-9-level-and-coronary-artery-calcification
#11
Xi Zhao, Hui-Wen Zhang, Sha Li, Yan Zhang, Rui-Xia Xu, Cheng-Gang Zhu, Na-Qiong Wu, Yuan-Lin Guo, Ping Qing, Xiao-Lin Li, Geng Liu, Qian Dong, Jing Sun, Jianjun Li
BACKGROUND: Plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) has been reported to be related to several risk factors and diseases such as inflammatory markers and coronary artery disease (CAD). The aim of present study was to investigate whether plasma PCSK9 level was associated with coronary artery calcification (CAC). METHODS: A total of 403 consecutive untreated patients with angina-like chest pain who received electron beam computed tomography (EBCT) were enrolled and a CAC score (CACS) was also measured...
January 1, 2017: Annals of Clinical Biochemistry
https://www.readbyqxmd.com/read/28145667/acute-coronary-syndrome-diagnostic-evaluation
#12
Craig Barstow, Matthew Rice, Jonathan D McDivitt
Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. Coronary artery disease is the leading cause of mortality in the United States. Chest pain is a common presentation in patients with MI; however, there are multiple noncardiac causes of chest pain, and the diagnosis cannot always be made based on initial presentation. The assessment of a possible MI includes evaluation of risk factors and presenting signs and symptoms, rapid electrocardiography, and serum cardiac troponin measurements...
February 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28138363/perforated-peptic-ulcer-an-update
#13
REVIEW
Kin Tong Chung, Vishalkumar G Shelat
Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported...
January 27, 2017: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28131609/geriatric-syncope-and-cardiovascular-risk-in-the-emergency-department
#14
Nissa J Ali, Shamai A Grossman
BACKGROUND: Syncope is a transient loss of consciousness that is caused by a brief loss in generalized cerebral blood flow. OBJECTIVE: This article reviews the background, epidemiology, etiologies, evaluation, and disposition considerations of geriatric patients with syncope, with a focus on cardiovascular risk. DISCUSSION: Although syncope is one of the most common symptoms in elderly patients presenting to the emergency department, syncope causes in geriatric patients can present differently than in younger populations, and the underlying etiology is often challenging to discern...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28108220/missed-myocardial-infarctions-in-ed-patients-prospectively-categorized-as-low-risk-by-established-risk-scores
#15
A J Singer, M P Than, S Smith, P McCullough, T W Barrett, R Birkhahn, M Reed, H C Thode, W D Arnold, L B Daniels, C de Filippi, G Headden, W F Peacock
STUDY OBJECTIVES: Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. METHODS: We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED)...
January 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28107211/type-2-myocardial-infarction-incidence-presentation-treatment-and-outcome-in-routine-clinical-practice
#16
Dragana Radovanovic, Thomas Pilgrim, Burkhardt Seifert, Philip Urban, Giovanni Pedrazzini, Paul Erne
AIMS: The clinical definition and optimal treatment for myocardial infarction (MI) type 2 (T2MI) are not well established. We assessed differences in presentation, treatment and outcomes of patients with MI type 1 (T1MI) and T2MI. METHODS: The data of MI patients enrolled in the AMIS Plus cohort with T2MI were compared with T1MI using propensity score matching. RESULTS: A total of 13 829 patients had T1MI and 1091 (7.3%) T2MI. Patients with T2MI were older, often female, with more risk factors and comorbidities, and less ST segment elevation...
January 19, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28105733/vitamin-d-supplementation-for-sickle-cell-disease
#17
REVIEW
Htoo Htoo Kyaw Soe, Adinegara Bl Abas, Nan Nitra Than, Han Ni, Jaspal Singh, Abdul Razzak Bin Mohd Said, Ifeyinwa Osunkwo
BACKGROUND: Sickle cell disease is a genetic chronic haemolytic and pro-inflammatory disorder. The clinical manifestations of sickle cell disease result from the presence of mutations on the beta globin genes that generate an abnormal haemoglobin product (called haemoglobin S) within the red blood cell. Sickle cell disease can lead to many complications such as acute chest syndrome, stroke, acute and chronic bone complications (including painful vaso-occlusive crisis, osteomyelitis, osteonecrosis and osteoporosis)...
January 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28104706/selecting-patients-with-non-st-elevation-acute-coronary-syndrome-for-coronary-angiography-a-nationwide-clinical-vignette-study-in-the-netherlands
#18
Josien Engel, Judith M Poldervaart, Ineke van der Wulp, Johannes B Reitsma, Martine C de Bruijne, Jeroen J H Bunge, Maarten J Cramer, Wouter J Tietge, Ruben Uijlings, Cordula Wagner
OBJECTIVE: Cardiac guidelines recommend that the decision to perform coronary angiography (CA) in patients with Non-ST-Elevation Acute Coronary Syndrome (NST-ACS) is based on multiple factors. It is, however, unknown how cardiologists weigh these factors in their decision-making. The aim was to investigate the importance of different clinical characteristics, including information derived from risk scores, in the decision-making of Dutch cardiologists regarding performing CA in patients with suspected NST-ACS...
January 19, 2017: BMJ Open
https://www.readbyqxmd.com/read/28094851/blood-transfusion-for-preventing-primary-and-secondary-stroke-in-people-with-sickle-cell-disease
#19
REVIEW
Lise J Estcourt, Patricia M Fortin, Sally Hopewell, Marialena Trivella, Winfred C Wang
BACKROUND: Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Stroke affects around 10% of children with sickle cell anaemia (HbSS). Chronic blood transfusions may reduce the risk of vaso-occlusion and stroke by diluting the proportion of sickled cells in the circulation...
January 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28081310/a-simple-risk-score-in-acute-st-elevation-myocardial-infarction-modified-acef-age-creatinine-and-ejection-fraction-score
#20
Arzu Kalaycı, Vecih Oduncu, Çetin Geçmen, Selim Topcu, Can Yücel Karabay, İbrahim Akın İzgi, Cevat Kırma
BACKGROUND/AIM: The aim of this study was to evaluate if the modified ACEF (age, creatinine, and ejection fraction) score is a predictor of major adverse cardiac and cerebrovascular events during 1 year of follow-up in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: We retrospectively enrolled 1632 consecutive patients who were admitted to our emergency department diagnosed with STEMI within 12 h of chest pain and treated with primary PCI...
December 20, 2016: Turkish Journal of Medical Sciences
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