Sample records for cardiac risk factors

  1. Risk factors of cardiac allograft vasculopathy

    Szczurek, Wioletta; Gąsior, Mariusz; Zembala, Marian


    Despite advances in prevention and treatment of heart transplant rejection, development of cardiac allograft vasculopathy (CAV) remains the leading factor limiting long-term survival of the graft. Cardiac allograft vasculopathy etiopathogenesis is not fully understood, but a significant role is attributed to endothelial cell damage, caused by immunological and non-immunological mechanisms. Immunological factors include the differences between the recipient's and the donor's HLA systems, the presence of alloreactive antibodies and episodes of acute rejection. Among the non-immunological factors the most important are the age of the donor, ischemia-reperfusion injury and cytomegalovirus infection. The classical cardiovascular risk factors (diabetes, hypertension, obesity and hyperlipidemia) are also important. This study presents an up-to-date overview of current knowledge on the vasculopathy etiopathogenesis and the role played by endothelium and inflammatory processes in CAV, and it also investigates the factors which may serve as risk markers of cardiac allograft vasculopathy. PMID:26855649

  2. Risk Factors for Sudden Cardiac Death: Risk Factors for Sudden Cardiac Death

    Niemeijer, Maartje


    markdownabstractSCD is a common cause of death, with around four to five million cases annually worldwide. Determining which persons are at high risk for SCD remains difficult, due to lack of knowledge on individual risk factors and because in the majority of cases, SCD is the first manifestation of cardiac disease. Therefore, this thesis had three aims: (i) to study the current and past incidence of SCD, (ii) to identify new risk factors for SCD in the general population, and (iii) to study ...

  3. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina;


    causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P ...AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...

  4. Cardiac risk factors: environmental, sociodemographic, and behavioral cardiovascular risk factors.

    Anthony, David; George, Paul; Eaton, Charles B


    Several environmental exposures are associated with increased risk of coronary heart disease (CHD). Exposure to secondhand smoke may increase the risk by as much as 25% to 30%. Exposure to third hand smoke, residual components of tobacco smoke that remain in the environment after a cigarette is extinguished, also appears to increase risk. These residual components can remain in rooms and automobiles for up to 30 years and enter the body through the skin or via inhalation or ingestion. Exposure to particulate matter air pollution from automobile emissions, power plants, and other sources is yet another environmental risk factor for CHD, resulting in tens of thousands of deaths annually in the United States. Exposure to other environmental toxins, particularly bisphenol A and phthalates, also has been linked to CHD. There are sociodemographic risks for CHD, with numerous studies showing that lower socioeconomic status is associated with higher risk. Behavioral risk factors include poor diet, such as frequent consumption of fast food and processed meals; sleep disturbance; and psychological stress, particularly related to marital or work issues. Finally, although high alcohol consumption is associated with increased CHD risk, moderate alcohol consumption (ie, less than 1 to 2 drinks/day), particularly of wine and possibly beer, appears to reduce the risk. PMID:24936715

  5. Risk Factors for Sudden Cardiac Death : Risk Factors for Sudden Cardiac Death

    M.N. Niemeijer (Maartje)


    markdownabstractSCD is a common cause of death, with around four to five million cases annually worldwide. Determining which persons are at high risk for SCD remains difficult, due to lack of knowledge on individual risk factors and because in the majority of cases, SCD is the first manifestation of

  6. Risk factors for cardiac complications after spine surgery

    Guyot, Juan P.; Cizik, Amy; Bransford, Richard; Bellabarba, Carlo; Lee, Michael J.


    Study design:  Registry study using prospectively collected data Objective:  To determine risk factors for cardiac complications in spine surgery. Methods:  The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, surgical invasiveness and adverse outcomes were prospectively recorded. The p...

  7. Risk factors and risk index of cardiac events in pregnant women with heart disease

    LIU Hua; HUANG Tao-tao; LIN Jian-hua


    Background Pregnant women with heart disease are at high risk.Studies of risk factors of these patients are of great significance to improve maternal and fetal outcomes.In this paper,we try to discuss the main risk factors of cardiac events in pregnant women with heart disease and to establish a risk assessment system.Methods A retrospective analysis was carried out for pregnancies in 1741 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and September 2010.A Logistic regression model was used to identify independent risk factors of cardiac events and calculate the risk index in pregnant women with heart disease.Results The composition of heart disease in pregnant women was arrhythmia (n=662,38.00%),congenital heart disease (CHD; n=529,30.40%),cardiomyopathy (n=327,18.80%),rheumatic heart disease (RHD; n=151,8.70%),and cardiopathy induced by pre-eclampsia (n=53,3.00%).Main cardiac events were heart failure (n=110,6.32%),symptomatic arrhythmia needing medication (n=43,2.47%),cardiac arrest (n=2,0.11%),syncope (n=3,0.17%),and maternal death (n=10,0.57%).Six independent risk factors to predict cardiac events in pregnant women with heart disease were cardiac events before pregnancy (heart failure,severe arrhythmia,cardiac shock,etc.,P=0.000),New York Heart Association (NYHA) class >ll (P=0.000),oxygen saturation <90% (P=0.018),pulmonary artery hypertention (PAH)>50 mmHg (P=0.025),cyanotic heart disease without surgical correction (P=0.015),and reduced left ventricular systolic function (ejection fraction <40%,P=0.003).Every risk factor was calculated as 1 score.The incidence of cardiac events in patients with scores 0,1,2,3,and ≥4 was 2.10%,31.61%,61.25%,68.97%,and 100.00% respectively.Conclusions Pregnancy with heart disease could lead to undesirable pregnancy outcomes.The risk of cardiac events in pregnant women with heart disease could be assessed by risk

  8. Radiation Therapy, Cardiac Risk Factors, and Cardiac Toxicity in Early-Stage Breast Cancer Patients

    Purpose: The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer. Methods and Materials: In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women ≥65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account. Results: Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs. Conclusion: It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years

  9. Preoperative cardiac risk management

    Vidaković Radosav; Poldermans Don; Nešković Aleksandar N.


    Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: 1) identified risk factors, and 2) the type of the surgical p...

  10. Clinical Implications and Risk Factors of Acute Pancreatitis after Cardiac Valve Surgery

    Chung, Joo Won; Ryu, Sung Ho; Jo, Jung Hyun; Park, Jeong Youp; Lee, Sak; Park, Seung Woo; Song, Si Young; Chung, Jae Bock


    Purpose Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. Materials and Methods We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancrea...

  11. Risk factors for delirium after on-pump cardiac surgery : A systematic review

    Gosselt, Alex N C; Slooter, Arjen J C; Boere, Pascal R Q; Zaal, Irene J.


    Introduction: As evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments ne

  12. Genetic risk factors for common and rare cardiac rhythm disorders

    R.F.J. Marsman


    Sudden cardiac death (SCD) is defined by abrupt and unexpected death due to a cardiac cause, most often attributed to sustained ventricular arrhythmias. Knowledge about the molecular pathways involved in SCD is necessary in order to develop preventive strategies and novel therapies. Insight into the

  13. Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile

    Rod, Naja Hulvej; Grønbaek, M; Schnohr, P;


    OBJECTIVE: The aim of this study was to evaluate the long-term effects of stress on changes in health behaviour and cardiac risk profile in men and women. DESIGN: A prospective cohort study. SETTING: The Copenhagen City Heart Study, Denmark. SUBJECTS: The analyses were based on 7066 women and men...... health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes). RESULTS: Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI...... in health behaviour and cardiac risk profile....

  14. Experience of cardiac rehabilitation after coronary artery surgery: effects on health and risk factors

    Lindsay, G.; Hanlon, W.P; Smith, L.N.; Belcher, P.R.


    Objective:Cardiac rehabilitation (CR) programs are provided to support the recovery process following acute myocardial infarction and coronary artery bypass grafting (CABG). Attendance varies. We related attendance following CABG to severity of cardiac symptoms, general health status (Short Form-36) and prevalence of modifiable coronary artery disease (CAD) risk factors. METHODS: 209 patients due to undergo CABG were recruited and assessed preoperatively as well as at a mean of 16.4 months po...

  15. Cardiac diseases as a risk factor for stroke in Saudi children

    Objective was to ascertain the role of cardiac diseases as a risk factor for stroke in a cohort of Saudi children who were evaluated in a retrospective and prospective study. Children with cardiac diseases were identified from within a cohort of 104 Saudi children who presented with stroke. They were seen as inpatients in the Pediatric Wards or evaluated at the Outpatient Clinics of the Division of Pediatric Neurology (DPN), and the Division of Pediatric Cardiology at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the periods July 1992 to February 2001 (retrospective study) and February 2001 to March 2003 (prospective study). A comprehensive form for clinical, neuroimaging, neurophysiological and laboratory data retrieval was designed and completed for each patient. Cardiac evaluation included 12-lead ECG and serial echocardiograms. Cardiac catheterization and 24-hour ambulatory ECG (Holter) were conducted on clinical discretion. Cardiac diseases were the underlying risk factor for stroke in 6 (5.8%) of the 104 children (aged one month to 12 years). The patients (4males and 2 females) were evaluated at the DPN at a mean age of 5.3 years (range=1-8 years; median 6.5 years). Onset of stroke was at a mean age of 34 months (range= 4 months - 8 years; median = 30 months). Five patients had stroke in association with congenital heart disease (CHD), whereas the sixth had restrictive cardiomyopathy. The identified CHD consisted of membranous ventricular septal defect in a 5-year-old boy who had moyamoya syndrome and sickle cell b-thalassemia, asymptomatic patent ductus arteriosus (PDA) in a 17-months-old girl, atrioventricular canal defect and PDA in an 8-year-old boy who also had Down syndrome, partial anomalous pulmonary venous drainage in a one-year-old boy. The latter patient developed hemiparesis secondary to a septic embolus, which evolved into brain abscess involving the right fronto-preital region. This was successfully managed surgically

  16. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management.

    Peretto, Giovanni; Durante, Alessandro; Limite, Luca Rosario; Cianflone, Domenico


    Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias. PMID:24511410

  17. Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management

    Giovanni Peretto


    Full Text Available Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery may warrant acute treatment and long-term preventive strategy in the absence of reversible causes. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur with the need for permanent pacing. We provide a complete and updated review about mechanisms, risk factors, and treatment strategies for the main postoperative arrhythmias.

  18. Cardiac Risk Assessment

    ... to assess cardiac risk include: High-sensitivity C-reactive protein (hs-CRP) : Studies have shown that measuring ... LDL-C but does not respond to typical strategies to lower LDL-C such as diet, exercise, ...

  19. Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation

    Gitt A


    Full Text Available Anselm Gitt1, Christina Jannowitz2, Marthin Karoff3, Barbara Karmann2, Martin Horack1, Heinz Völler4,51Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen,2Medical Affairs, MSD Sharp and Dohme GmbH, Haar, 3Klinik Königsfeld der Deutschen Rentenversicherung Westfalen in Ennepetal (NRW, Klinik der Universität Witten-Herdecke, 4Kardiologie, Klinik am See, Rüdersdorf, 5Center of Rehabilitation Research, University Potsdam, GermanyAim: Metabolic syndrome (MetS is a clustering of factors that are associated with increased cardiovascular risk. We aimed to investigate the proportion of patients with MetS in patients undergoing cardiac rehabilitation (CR, and to describe differences between patients with MetS compared to those without MetS with regard to (1 patient characteristics including demographics, risk factors, and comorbidities, (2 risk factor management including drug treatment, and (3 control status of risk factors at entry to CR and discharge from CR.Methods: Post-hoc analysis of data from 27,904 inpatients (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry that underwent a CR period of about 3 weeks were analyzed descriptively in total and compared by their MetS status.Results: In the total cohort, mean age was 64.3 years, (71.7% male, with no major differences between groups. Patients had been referred after a ST elevation of myocardial infarction event in 41.1% of cases, non-ST elevation of myocardial infarction in 21.8%, or angina pectoris in 16.7%. They had received a percutaneous coronary intervention in 55.1% and bypass surgery (coronary artery bypass graft in 39.5%. Patients with MetS (n = 15,819 compared to those without MetS (n = 12,085 were less frequently males, and in terms of cardiac interventions, more often received coronary artery bypass surgery. Overall, statin use increased from 79.9% at entry to 95.0% at discharge (MetS: 79.7% to 95.2%. Patients with Met

  20. Agile text mining for the 2014 i2b2/UTHealth Cardiac risk factors challenge.

    Cormack, James; Nath, Chinmoy; Milward, David; Raja, Kalpana; Jonnalagadda, Siddhartha R


    This paper describes the use of an agile text mining platform (Linguamatics' Interactive Information Extraction Platform, I2E) to extract document-level cardiac risk factors in patient records as defined in the i2b2/UTHealth 2014 challenge. The approach uses a data-driven rule-based methodology with the addition of a simple supervised classifier. We demonstrate that agile text mining allows for rapid optimization of extraction strategies, while post-processing can leverage annotation guidelines, corpus statistics and logic inferred from the gold standard data. We also show how data imbalance in a training set affects performance. Evaluation of this approach on the test data gave an F-Score of 91.7%, one percent behind the top performing system. PMID:26209007

  1. Risk factors for delayed graft function in cardiac death donor renal transplants

    SHAO Ming-jie; YE Qi-fa; MING Ying-zi; SHE Xing-guo; LIU Hong; YE Shao-jun; NIU Ying


    Background Delayed graft function (DGF) is common in kidney transplants from organ donation after cardiac death (DCD) donors.It is associated with various factors.Determination of center-specific risk factors may help to reduce the incidence of DGF and improve the transplantation results.The aim of this study is to define risk factors of DGF after renal transplantation.Methods From March 2010 to June 2012,56 cases of recipients who received DCD kidneys were selected.The subjects were divided into two groups:immediate graft function (IGF) and DGF groups.Transplantation factors of donors and recipients as well as early post-transplant results of recipients were compared between the two groups.Results On univariate analysis,preoperative dialysis time of recipients (P<0.001),type of dialysis (P=0.039),human leucocyte antigen (HLA) mismatch sites (P<0.001),the cause of brain death (P=0.027),body mass index (BMI) of donors (P<0.001),preoperative infection (P=0.002),preoperative serum creatinine of donors (P <0.001),norepinephrine used in donors (P <0.001),cardiopulmonary resuscitation (CPR) of donors (P <0.001),warm ischemia time (WIT) (P<0.001) and cold ischemia time (CIT) (P<0.001) showed significant differences.Recipients who experienced DGF had a longer hospital stay,and higher level of postoperative serum creatinine.Conclusion Multiple risk factors are associated with DGF,which had deleterious effects on the early post-transplant period.

  2. Cardiac comorbidity is an independent risk factor for radiation-induced lung toxicity in lung cancer patients

    Purpose: To test the hypothesis that cardiac comorbidity before the start of radiotherapy (RT) is associated with an increased risk of radiation-induced lung toxicity (RILT) in lung cancer patients. Material and methods: A retrospective analysis was performed of a prospective cohort of 259 patients with locoregional lung cancer treated with definitive radio(chemo)therapy between 2007 and 2011 ( Identifiers: NCT00572325 and NCT00573040). We defined RILT as dyspnea CTCv.3.0 grade ⩾2 within 6 months after RT, and cardiac comorbidity as a recorded treatment of a cardiac pathology at a cardiology department. Univariate and multivariate analyses, as well as external validation, were performed. The model-performance measure was the area under the receiver operating characteristic curve (AUC). Results: Prior to RT, 75/259 (28.9%) patients had cardiac comorbidity, 44% of whom (33/75) developed RILT. The odds ratio of developing RILT for patients with cardiac comorbidity was 2.58 (p < 0.01). The cross-validated AUC of a model with cardiac comorbidity, tumor location, forced expiratory volume in 1 s, sequential chemotherapy and pretreatment dyspnea score was 0.72 (p < 0.001) on the training set, and 0.67 (p < 0.001) on the validation set. Conclusion: Cardiac comorbidity is an important risk factor for developing RILT after definite radio(chemo)therapy of lung cancer patients

  3. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e


    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  4. Effect of Intense Lifestyle Modification and Cardiac Rehabilitation on Psychosocial Cardiovascular Disease Risk Factors and Quality of Life

    Aldana, Steven G.; Whitmer, William R.; Greenlaw, Roger; Avins, Andrew L.; Thomas, Dean; Salberg, Audrey; Greenwell, Andrea; Lipsenthal, Lee; Fellingham, Gill W.


    This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR) on psychosocial risk factors and quality of life in patients with confirmed coronary artery disease. Participants had previously undergone a revascularization procedure. The 84 patients self-selected to participate in the Ornish Program…

  5. Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

    LIU Zi-jia; YU Chun-hua; XU Li; HAN Wei; JIANG Jing-mei; HUANG Yu-guang


    Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery.This study examined the incidence and risk factors for perioperative MACE in elderly patients who underwent noncardiac surgery,and established a risk stratification system.Methods This retrospective observational clinical study included 482 patients aged >60 years with CHD who underwent elective major noncardiac surgery at the Peking Union Medical College Hospital.The primary outcome was MACE within 30 days after surgery.Risk factors were evaluated using multivariate Logistic regression analysis.Results Perioperative MACE occurred in 61(12.66%) of the study patients.Five independent risk factors for perioperative MACE were identified:history of heart failure,preoperative arrhythmia,preoperative diastolic blood pressure <75 mmHg,American Society of Anesthesiologists grade 3 or higher,and intraoperetive blood transfusion.The area under the receiver operating characteristic curve for the risk-index score was 0.710±0.037.Analysis of the risk stratification system showed that the incidence of perioperative MACE increased significantly with increasing levels of risk.Conclusions Elderly Chinese patients with CHD who undergo noncardiac surgery have a high risk of perioperative MACE.Five independent risk factors for perioperative MACE were identified.Our risk stratification system may be useful for assessing perioperative cardiac risk in elderly patients undergoing noncardiac surgery.

  6. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    Lynch, Johanne


    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  7. The impact of lifestyle-related risk factors on cardiac response to ischemia and possibilities to restore impaired ischemic tolerance

    Ravingerová, T.; Čarnická, S.; Nemčeková, M.; Ledvényiová, V.; Adameová, A.; Khandelwal, V. K. M.; Zálešák, M.; Kolář, František


    Roč. 61, Suppl.2 (2012), S1-S10. ISSN 0862-8408 R&D Projects: GA MŠk 7AMB12SK164 Institutional research plan: CEZ:AV0Z50110509 Institutional support: RVO:67985823 Keywords : lifestyle risk factors * myocardial ischemia * gender -related differences * cardiac adaptation * pleiotropic effects Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.531, year: 2012

  8. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study.

    Kabbani, Mohamed S; Ismail, Sameh R; Fatima, Anis; Shafi, Rehana; Idris, Julinar A; Mehmood, Akhter; Singh, Reetam K; Elbarabry, Mahmoud; Hijazi, Omar; Hussein, Mohamed A


    Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (pcongenital abnormalities of kidney and urinary tract (CAKUT) (purinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. PMID:26829892

  9. Cardiac diastolic dysfunction is associated with cerebral white matter lesions in elderly patients with risk factors for atherosclerosis

    Cerebral white matter lesions on magnetic resonance imaging (MRI) are considered to be the result of brain ischemic injury and a risk factor for clinical stroke. The purpose of this study was to elucidate the relationship between the cardiac diastolic function and cerebral white matter lesions in elderly patients with risk factors for atherosclerosis. The study subjects were 55 patients (75±7 years) with risk factors for atherosclerosis including hypertension, diabetes mellitus, and dyslipidemia. Patients with symptomatic cerebrovascular events were excluded from the study. Cerebral white matter lesions, which were defined as exhibiting high intensity regions on brain MRI, were evaluated with the degrees of periventricular hyperintensity (PVH) according to the Japanese Brain Dock Guidelines of 2003. Peak early diastolic mitral annular velocity (E' velocity) was measured by tissue Doppler echocardiography, and was used as a parameter of cardiac diastolic function. The mean value of E' velocity was decreased due to the cardiac diastolic dysfunction (5.2±1.4 cm/s). In addition, the E' velocity was inversely correlated with the degree of PVH (ρ=-0.701, p<0.001). Stepwise regression analysis showed that the decrease in the E' velocity (β coefficient=-0.42, p<0.001) and the presence of hypertension (β coefficient=0.31, p=0.001) were independent determinants of the degree of PVH. Thus, cardiac diastolic dysfunction is correlated to the severity of cerebral white matter lesions, suggesting the cardio-cerebral connection in elderly patients with risk factors for atherosclerosis. (author)

  10. Psychological Factors and Cardiac Risk And Impact of Exercise Training Programs—A Review of Ochsner Studies

    Lavie, Carl J.; Milani, Richard V.; Artham, Surya M.; Gilliland, Yvonne


    Although under-emphasized, substantial evidence indicates that psychological distress, especially depression, hostility, and anxiety, are risk factors for coronary heart disease (CHD) and affect recovery following major coronary heart disease events. We review several major studies from Ochsner Medical Center demonstrating the high prevalence of psychological distress in CHD patients and the marked benefits that occur following formal cardiac rehabilitation and exercise training programs. The...

  11. High thoracic epidural anesthesia in cardiac surgery: risk factors for arterial hypotension.

    Casalino, Stefano; Mangia, Fabio; Stelian, Edmond; Novelli, Eugenio; Diena, Marco; Tesler, Ugo F


    There is an interest in the use of high thoracic epidural anesthesia in cardiac surgery, because experimental and clinical studies have suggested that central neuroaxial blockade attenuates the response to surgical stress and improves myocardial metabolism and perioperative analgesia-thus enabling earlier extubation and a smoother postoperative course. Matters of major concern in the adoption of high thoracic epidural anesthesia in cardiac surgery are neurologic injury secondary to neuroaxial hematoma and hypotension secondary to sympatholysis. The risk associated with possible neuraxial hematoma caused by high thoracic epidural anesthesia has been thoroughly investigated and largely discounted, but scant attention has been devoted to the onset of hypotensive episodes in the same setting. We analyzed the hypotensive episodes that occurred in a series of 144 patients who underwent on-pump cardiac surgery procedures. Among the patient variables that we tested in a multivariate logistic-regression model, only female sex was found to be significantly correlated with hypotension. In order to decrease the incidence and severity of hypotensive episodes resulting from anesthetic blockade, anesthesiologists need to monitor, with special care, women patients who are under high thoracic epidural anesthesia. Further studies are needed in order to determine why women undergoing open heart surgery under high thoracic epidural anesthesia are at a relatively greater risk of hypotension. PMID:16878616

  12. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level

    Völler H


    Full Text Available Kurt Bestehorn1, Christina Jannowitz2, Martin Horack3, Barbara Karmann2, Martin Halle4, Heinz Völler5 1Institute for Clinical Pharmacology, Technical University, Dresden; 2Medical Department, MSD Sharp and Dohme GmbH, Haar; 3Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen; 4Center for Prevention and Sports Medicine, Technical University, Munich; 5Klinik am See, Rehabilitation Center for Cardiovascular Diseases, Rüdersdorf, Germany Background: After the acute hospital stay, most cardiac patients in Germany are transferred for a 3–4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university. Methods: Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results: In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7% were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6% or coronary bypass surgery (39.5%. Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol <100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes

  13. Aging is an Important Cause for a Lack of Understanding of the Main Risk Factor in Cardiac Rehabilitation Patients



    Full Text Available Background Age, one of the key biomarkers among the nonclinical parameters of cardiovascular diseases (CVDs, has the greatest effect on the development and progression of CVDs. Objectives The current study was done to evaluate the effect of age on cardiac rehabilitation (CR patients’ attitudes regarding the main cause of their condition. Patients and Methods The administrative data of this cross-sectional study were obtained from the database of the CR department of a hospital in Iran. The demographic and clinical information of 901 patients was obtained from January 2004 and January 2012 using compiled forms of this database and the structured clinical interview for Axis I Disorders (SCID-I. Univariate analysis of variance and Bonferroni post-hoc analysis were used for the data analysis. Results After adjusting for gender, it was revealed that significant age differences existed between patients who perceived no specific risk factors (62.43 years and those who viewed biological (55.0, physiological (57.31, behavioral (57.85, and psychological (57.25 risk factors as the main cause of their condition (P < 0.05. The age differences between those who had no perceived risk factors (62.43 was significantly different from patients perceiving biological (55.0 and environmental (62.03 factors to be the main cause (P < 0.05. Conclusions Although older patients need more self-care and the quality of this self-care originates from their attitude toward CVD risk factors, their lack of awareness about the main risk factor of their condition is a major challenge for secondary prevention measures. In addition, younger patients’ significant emphasis on biological risk factors as uncorrectable factors can reduce their sense of responsibility toward attempting to control correctable risk factors. Correcting these patients’ attitudes regarding CVD risk factors can result in better responsibility feeling by the patients and can improve treatment outcomes.

  14. Gender Differences in Patients' Beliefs About Biological, Environmental, Behavioral, and Psychological Risk Factors in a Cardiac Rehabilitation Program

    Mozhgan Saeidi


    Full Text Available Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs, physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test​​. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P


    "M. J. Mahmoudi


    Full Text Available Prevention of coronary heart disease, mainly by reducing the levels of known risk factors in the population, remains a priority in public health. This cross-sectional study on randomly selected medical students during their internship was conducted from July 2001 to April 2002 in order to determine the prevalence of major coronary artery disease (CAD risk factors. This survey was done by filling the questionnaire, measuring physical parameters, and taking a fasting blood sample. Two hundred and sixty four medical students were evaluated in this study (48 female, 216 male with the mean age of 26.5 ± 2.8 years. The main risk factors in descending order of frequency were physical inactivity (43.5%, low high-density lipoprotein cholesterol (26.2%, family history of premature CAD (15.9%, smoking (10.3%, abdominal obesity (10.2%, high triglyceride level (5.3%, high blood pressure (3.4%, and high low-density lipoprotein cholesterol (1.5%. Also, 25% of married females were using oral contraceptives regularly. The number of risk factors per person was 2.2 on average (1.1 in females and 2.5 in males. Prevalence of CAD risk factors in this medical students’ population was unacceptably high. Additional studies should be done to gather more information and determine the need for preventive, educational or curative interventions.

  16. Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

    Cai-Jun Wu; Zhi-Jun Guo; Chun-Sheng Li; Yi Zhang; Jun Yang


    Background:Animal models of asphyxiation cardiac arrest (ACA) are frequently used in basic research to mirror the clinical course of cardiac arrest (CA).The rates of the return of spontaneous circulation (ROSC) in ACA animal models are lower than those from studies that have utilized ventricular fibrillation (VF) animal models.The purpose of this study was to characterize the factors associated with the ROSC in the ACA porcine model.Methods:Forty-eight healthy miniature pigs underwent endotracheal tube clamping to induce CA.Once induced,CA was maintained untreated for a period of 8 min.Two minutes following the initiation of cardiopulmonary resuscitation (CPR),defibrillation was attempted until ROSC was achieved or the animal died.To assess the factors associated with ROSC in this CA model,logistic regression analyses were performed to analyze gender,the time of preparation,the amplitude spectrum area (AMSA) from the beginning of CPR and the pH at the beginning ofCPR.A receiver-operating characteristic (ROC) curve was used to evaluate the predictive value of AMSA for ROSC.Results:ROSC was only 52.1% successful in this ACA porcine model.The multivariate logistic regression analyses revealed that ROSC significantly depended on the time of preparation,AMSA at the beginning of CPR and pH at the beginning of CPR.The area under the ROC curve in for AMSA at the beginning of CPR was 0.878 successful in predicting ROSC (95% confidence intervals:0.773~0.983),and the optimum cut-off value was 15.62 (specificity 95.7% and sensitivity 80.0%).Conclusions:The time of preparation,AMSA and the pH at the beginning of CPR were associated with ROSC in this ACA porcine model.AMSA also predicted the likelihood of ROSC in this ACA animal model.

  17. Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

    Cai-Jun Wu


    Full Text Available Background: Animal models of asphyxiation cardiac arrest (ACA are frequently used in basic research to mirror the clinical course of cardiac arrest (CA. The rates of the return of spontaneous circulation (ROSC in ACA animal models are lower than those from studies that have utilized ventricular fibrillation (VF animal models. The purpose of this study was to characterize the factors associated with the ROSC in the ACA porcine model. Methods: Forty-eight healthy miniature pigs underwent endotracheal tube clamping to induce CA. Once induced, CA was maintained untreated for a period of 8 min. Two minutes following the initiation of cardiopulmonary resuscitation (CPR, defibrillation was attempted until ROSC was achieved or the animal died. To assess the factors associated with ROSC in this CA model, logistic regression analyses were performed to analyze gender, the time of preparation, the amplitude spectrum area (AMSA from the beginning of CPR and the pH at the beginning of CPR. A receiver-operating characteristic (ROC curve was used to evaluate the predictive value of AMSA for ROSC. Results: ROSC was only 52.1% successful in this ACA porcine model. The multivariate logistic regression analyses revealed that ROSC significantly depended on the time of preparation, AMSA at the beginning of CPR and pH at the beginning of CPR. The area under the ROC curve in for AMSA at the beginning of CPR was 0.878 successful in predicting ROSC (95% confidence intervals: 0.773∼0.983, and the optimum cut-off value was 15.62 (specificity 95.7% and sensitivity 80.0%. Conclusions: The time of preparation, AMSA and the pH at the beginning of CPR were associated with ROSC in this ACA porcine model. AMSA also predicted the likelihood of ROSC in this ACA animal model.

  18. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery

    Associated coronary artery disease is the critical factor that influences early and late mortality after abdominal aortic aneurysm surgery. Dipyridamole-thallium 201 scintigraphy, left ventricular ejection fraction, and Goldman risk factor analysis have been suggested as preoperative noninvasive screening methods to detect significant coronary artery disease. In this series of 95 elective abdominal aortic aneurysm repairs dipyridamole-thallium 201 scintigraphy was highly predictive of the absence of perioperative cardiac morbidity (96% specificity, 44/46 normal scans, no cardiac morbidity), whereas ejection fraction (73% specificity, 31/42 normal ejection fraction, no cardiac morbidity) and Goldman risk factor analysis (84% specificity, 44/51 class I, no cardiac morbidity) were less. Furthermore, thallium redistribution on dipyridamole-thallium 201 scintigraphy leading to coronary angiography identified a significant number of patients with occult coronary artery disease who required preoperative coronary revascularization (8%, 8/95) and might have remained undetected on the basis of left ventricular ejection fraction or Goldman risk factor analysis. Finally, fixed thallium deficit, which some investigators have interpreted as a low probability finding for cardiac morbidity, was associated with a higher than expected incidence of cardiac complications. Forty-six percent (7/15) of all postoperative cardiac complications (three myocardial infarctions, three ischemic events, one death) occurred in patients with abdominal aortic aneurysms with fixed deficits. This suggests that patients with fixed deficits on dipyridamole-thallium 201 scintigraphy should be considered for later delayed (4 hours) thallium images or coronary angiography or both

  19. Radiation-induced cardiac damage in early left breast cancer patients: Risk factors, biological mechanisms, radiobiology, and dosimetric constraints

    Today there is general awareness of the potential damage to the heart in left-sided (more than in right-sided) breast cancer radiotherapy (RT). Historical changes in tumor and heart doses are presented here along with the impact of different RT techniques and volumes. Individual and pharmacological risk factors are also examined with respect to radiation damage. The biological mechanisms of harm are only partially understood, such as the radiobiology of heart damage due to the presence of various radiosensitive structures and their topographic heterogeneity. Furthermore, individual variability may expose patients to higher or lower risks of late cardiac damage or death. Damage mechanisms and radiobiological characteristics in heart irradiation are presented in relation to dosimetric and biological parameters.

  20. Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

    Wang Xuelihong; Guo Xuewei; Ma Yushan; Su Shuangshan; Guo Xiangyu


    Objectives To evaluate the effect of different styles of coronary heart disease (CHD),different regions of acute myocardial infarction (AMI),its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD (NoCHD) were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris(SAP) 26, unstable angina pectoris(UAP) 53, acute myocardial infarction (AMI) 140 and old myocardial infarction (OMI) 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct (Aa,n =53), acute inferior myocardial infarction(Ai, n=54)and Aa+Ai(n=33) based on ECG. Cardiac parameters:end-diastolic interventricular septum thickness (IVSd),end-diastolic left ventricular internal diameter(LVd ),left ventricular mass (LM), end-diastolic left ventricular volume (EDV), end-systolic left ventricular volume (ESV) and left ventricular ejection fraction(LVEF) were measured by ACUSON 128XP/10 echocardiography.Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP (P<0.05-0.0001). LM was mainly increased in patients with OMI (P<0.01) and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa+Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF

  1. Study of some risk factors and accelerating factors of heart attack and the delay reasons in referring to theMazandaran Cardiac Center in 2009

    Hedayat Jafari


    Full Text Available 12 3 4 (Received 21 October, 2009 ; Accepted 13 January, 2010AbstractBackground and purpose: Coronary artery disease (CAD particularly of the acute myocardial infraction (MI is one of the main causes of mortality in the developing countries. Considering the complication of the disease, the aim of this study was to investigate risk and accelerating factors of heart attack and the reason of the patients' delay in referring to Mazandaran Cardiac Center in 2009.Materials and methods: This cross-sectional study was preformed on 200 acute myocardial infarction (AMI patients. The criteria of diagnosis for AMI in this study was ST elevation of ECG, increase of CKMB above 25 in three phases and increase of Troponin-1 above 1nd/ml and also LDH increase: The demographic information, history of having specific and related disease and the heart attack accelerating factors and the reason of delay in referring to cardiac center was recorded in questionnaire. The collected data were coded, then analyzed by X2 test and ANOVA test using u. SPSS soft wave.Results: Of 200 patients under study, 57% were male. With mean age and BMI of 62.02 years and of 26.66 respectively. The major risk factor in incidence of heart attack in this study first was high blood pressure (24.7 % and the second one was diabetes mellitus 15.5 %. The accelerating factors of heart attack were heavy physical activity (25.3 %, sudden wake ups (25.2 %, and mental work along with tension (12.6 % respectively.Conclusion: Considering the risk factors and heart attack accelerating factors, providing proper education to the public, it is possible it reduce the number of heart attack cases and implement proper strategy to reduce the delay in referring of such patients to a cardiac center. J Mazand Univ Med Sci 2009; 19(73: 69-74 (Persian.

  2. Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

    Mahdi Ait Houssa; Noureddine Atmani; Fouad Nya; Abdessamad Abdou; Younes Moutakiallah; Mehdi Bamous; Mohamed Drissi; Abdelatif Boulahya


    Stress ulcer lesions of upper gastrointestinal tract are well recognized in patients undergoing open cardiac surgery. Gastrointestinal bleeding following cardiac surgery is infrequent with significant morbidity and mortality. The pathogenesis of mucosal lesions and subsequent haemorrhage is complex and multifactorial. The diagnosis as well as the treatment of this complication remains a challenge for surgeons. Identifying the source of bleeding can be difficult. Despite of the successful con...

  3. Sudden Cardiac Death in Young Adults: Environmental Risk Factors and Genetic Aspects of Premature Atherosclerosis*(,) †

    Larsen, Maiken K; Nissen, Peter H; Kristensen, Ingrid B;


    Familial hypercholesterolemia (FH) is a genetic disorder that may lead to premature coronary heart disease (CHD) and sudden cardiac death (SCD). Mutations in the LDLR or APOB genes cause FH. We have screened the LDLR and the ligand-binding region of APOB genes in 52 cases of SCD. Deceased patient...

  4. Sudden Cardiac Arrest (SCA) Risk Assessment

    ... Find a Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without ... of all ages and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool ...

  5. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

    Wei WANG


    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  6. “What the Eyes Don’t See, the Heart Doesn’t Grieve Over”: Epidemiology and Risk Factors for Bloodstream Infections following Cardiac Catheterization

    Dicks, Kristen V.; Staheli, Russell; Anderson, Deverick J.; Miller, Becky A.; Jones, W. Schuyler; Harrison, J. Kevin; Sexton, Daniel J.; Moehring, Rebekah W.; Chen, Luke F.


    No standard definition exists for surveillance and characterization of the epidemiology of bloodstream infections (BSIs) after cardiac catheterization (CC) procedures. We proposed a novel case definition and determined the epidemiology and risk factors of BSIs after CC procedure using this new definition.

  7. Incidence, risk factors and prediction of post-operative acute kidney injury following cardiac surgery for active infective endocarditis: an observational study

    Legrand, Matthieu; Pirracchio, Romain; Rosa, Anne; Petersen, Maya L.; van der Laan, Mark; Fabiani, Jean-Noël; Fernandez-gerlinger, Marie-paule; Podglajen, Isabelle; Safran, Denis; Cholley, Bernard; Mainardi, Jean-Luc


    Abstract Introduction Cardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. The purpose of the study was to determine the risk factors for post-operative AKI in patients operated on for IE. Methods A retrospective, non-interventional study of prospectively collected data (2000–2010) included ...

  8. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Alireza Abdollahi Moghaddam


    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  9. Cardiac morbidity risk and depression and anxiety

    Tully, Phillip J; Pedersen, Susanne S.; Winefield, Helen R;


    The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity...... personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research........ Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom...

  10. Resistance in gram-negative bacilli in a cardiac intensive care unit in India: Risk factors and outcome

    Pawar Mandakini


    Full Text Available The objective of this study was to compare the risk factors and outcome of patients with preexisting resistant gram-negative bacilli (GNB with those who develop sensitive GNB in the cardiac intensive care unit (ICU. Of the 3161 patients ( n = 3,161 admitted to the ICU during the study period, 130 (4.11% developed health care-associated infections (HAIs with GNB and were included in the cohort study. Pseudomonas aeruginosa (37.8% was the most common organism isolated followed by Klebsiella species (24.2%, E. coli (22.0%, Enterobacter species (6.1%, Stenotrophomonas maltophilia (5.7%, Acinetobacter species (1.3%, Serratia marcescens (0.8%, Weeksella virosa (0.4% and Burkholderia cepacia (0.4%. Univariate analysis revealed that the following variables were significantly associated with the antibiotic-resistant GNB: females ( P = 0.018, re-exploration ( P = 0.004, valve surgery ( P = 0.003, duration of central venous catheter ( P < 0.001, duration of mechanical ventilation ( P < 0.001, duration of intra-aortic balloon counter-pulsation ( P = 0.018, duration of urinary catheter ( P < 0.001, total number of antibiotic exposures prior to the development of resistance ( P < 0.001, duration of antibiotic use prior to the development of resistance ( P = 0.014, acute physiology and age chronic health evaluation score (APACHE II, receipt of anti-pseudomonal penicillins (piperacillin-tazobactam ( P = 0.002 and carbapenems ( P < 0.001. On multivariate analysis, valve surgery (adjusted OR = 2.033; 95% CI = 1.052-3.928; P = 0.035, duration of mechanical ventilation (adjusted OR = 1.265; 95% CI = 1.055-1.517; P = 0.011 and total number of antibiotic exposure prior to the development of resistance (adjusted OR = 1.381; 95% CI = 1.030-1.853; P = 0.031 were identified as independent risk factors for HAIs in resistant GNB. The mortality rate in patients with resistant GNB was significantly higher than those with sensitive GNB (13.9% vs. 1.8%; P = 0.03. HAI with

  11. Cardiac Rehabilitation: Improving Function and Reducing Risk.

    Servey, Jessica T; Stephens, Mark


    Cardiac rehabilitation is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. The overall goals focus on improving daily function and reducing cardiovascular risk factors. Cardiac rehabilitation includes interventions aimed at lowering blood pressure and improving lipid and diabetes mellitus control, with tobacco cessation, behavioral counseling, and graded physical activity. The physical activity component typically involves 36 sessions over 12 weeks, during which patients participate in supervised exercise under cardiac monitoring. There are also intensive programs that include up to 72 sessions lasting up to 18 weeks, although these programs are not widely available. Additional components of cardiac rehabilitation include counseling on nutrition, screening for and managing depression, and assuring up-to-date immunizations. Cardiac rehabilitation is covered by Medicare and recommended for patients following myocardial infarction, bypass surgery, and stent placement, and for patients with heart failure, stable angina, and several other conditions. Despite proven benefits in mortality rates, depression, functional capacity, and medication adherence, rates of referral for cardiac rehabilitation are suboptimal. Groups less likely to be referred are older adults, women, patients who do not speak English, and persons living in areas where cardiac rehabilitation is not locally available. Additionally, primary care physicians refer patients less often than cardiologists and cardiothoracic surgeons. PMID:27386722

  12. Simvastatin mitigates increases in risk factors for and the occurrence of cardiac disease following 10 Gy total body irradiation

    Lenarczyk, Marek; Su, Jidong; Haworth, Steven T.; Komorowski, Richard; Fish, Brian L; Migrino, Raymond Q.; Harmann, Leanne; Hopewell, John W.; Kronenberg, Amy; Patel, Shailendra; Moulder, John E.; Baker, John E


    The ability of simvastatin to mitigate the increases in risk factors for and the occurrence of cardiac disease after 10 Gy total body irradiation (TBI) was determined. This radiation dose is relevant to conditioning for stem cell transplantation and threats from radiological terrorism. Male rats received single dose TBI of 10 Gy. Age-matched, sham-irradiated rats served as controls. Lipid profile, heart and liver morphology and cardiac mechanical function were determined for up to 120 days af...

  13. Coronary calcium score in 12-year breast cancer survivors after adjuvant radiotherapy with low to moderate heart exposure – Relationship to cardiac radiation dose and cardiovascular risk factors

    Background/purpose: We explored the relation between coronary artery calcium (CAC) and cardiac radiation doses in breast cancer survivors (BCS) treated with radiotherapy (RT). Additionally, we examined the impact of other risk factors and biomarkers of coronary artery disease (CAD). Materials and methods: 236 BCS (median age 51 years [range 30–70], median observation time 12 years [9.2–15.7]), treated with 4-field RT of 50GY, were included and examined in 2004 (T1), 2007 (T2) and 2011 (T3) with clinical examination, blood tests and questionnaires. At T3, cardiac computed tomography was performed with quantification of CAC using Agatston score (AS). For 106 patients cardiac dose volume histograms were available. Results: The cohort-based median of the mean cardiac dose was 2.5 (range 0.5–7.0) Gy. There was no correlation between measures of cardiac dose and AS. AS was correlated with high cholesterol at T1/T2 (p = 0.022), high proBNP at T1/T2 (p < 0.022) and T3 (p < 0.022) and high HbA1c at T3 (p = 0.022). In addition, a high AS was significantly associated with hypertension (p = 0.022). Age (p < 0.001) and cholesterol at T1/T2 (p = 0.001) retained significant associations in multivariate analysis. Conclusions: Traditional, modifiable risk factors of CAD correlate with CAC and may be important for the long term risk of CAD after RT. With low to moderate cardiac radiation exposure, a contribution of radiation dose to CAC could not be demonstrated

  14. Baseline leukocyte count and acute coronary syndrome: predictor of adverse cardiac events, long and short term mortality and association with traditional risk factors, cardiac biomarkers and C-reactive protein

    The elevated WBC count has been accepted as part of healing response following myocardial infarction as well as a predictor of adverse cardiovascular events. The study was designed to find out correlation between WBC count and coronary risk factors, cardiac biomarkers, C-reactive protein (CRP), incidence of adverse cardiac events and mortality in patients of ACS in Pakistan. Methods: One hundred and thirty-three patients of ACS were stratified according to WBC categories, WBC1 (10,000/mm/sup 3/). The WBCs were counted on admission by Sysmex cell counter, CRP by immunoturbidimetric method, and CK-MB and Trop-I by enzyme immunoassay. Adverse cardiac events and mortality were recorded for 12 months of follow up period. Results: Long term mortality in patients with ACS was 6.4% in WBC1, 18.2% in WBC2 and 40.9% in WBC3 categories, while short term mortality was 2.6%, 3.0% and 18.2% in WBC1, WBC2, and WBC3 categories respectively. Relative to patients in lower 2 WBC categories, patients in the highest category were 7 times more likely to die during 30 days (HR 7.83, p=0.017) and more than 9 times during the total follow up period (HR 9.42, p<0.001). Cox regression analysis showed WBC3 a strong independent predictor of mortality (HR 6.36, p=0.016). WBC count showed a positive correlation with coronary risk factors, cardiac biomarkers and CRP. Conclusion: WBC count is a strong independent predictor of mortality in patients with ACS and has positive correlation with coronary risk factors, cardiac biomarkers and CRP. (author)

  15. Risk Factors

    ... Depression has been found to be a risk factor for development of heart disease. Depression occurs in up to 20% of people with ... and has been found to be a risk factor also for subsequent heart attack, the ... Fortunately, depression in patients with heart disease responds well to ...

  16. Risk factors

    This article deals with the development of risk management in the gas sector business: why a risk factor legal mention must precede any published financial information? Do gas companies have to face new risks? Is there specific risks bound to gas activities? Why companies want to master their risks? Is it mandatory or just a new habit? Do they expect a real benefit in return? These are the risk management questions that are analyzed in this article which is based on the public communication of 15 gas companies randomly selected over the world. The information comes from their annual reports or from documents available on their web sites. The intention of this document is not to be exhaustive or to make statistics but only to shade light on the risk factors of the gas sector. (J.S.)

  17. Emotion Risk-Factor in Patients With Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study)

    Bahremand, Mostafa; Alikhani, Mostafa; Zakiei, Ali; Janjani, Parisa; Aghaei, Abbas


    Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases. PMID:26234976

  18. The Prevalence of Cardiac Risk Factors in Men with Localized Prostate Cancer Undergoing Androgen Deprivation Therapy in British Columbia, Canada

    Margot K. Davis


    Full Text Available Background. While androgen deprivation therapy (ADT reduces the risk of prostate cancer-specific mortality in high-risk localized prostate cancer, it adversely affects cardiovascular (CV risk factor profiles in treated men. Methods. We retrospectively reviewed the charts of 100 consecutive men with intermediate- or high-risk localized prostate cancer referred to the British Columbia Cancer Agency for ADT. Data on CV risk factors and disease were collected and Framingham risk scores were calculated. Results. The median age of the study cohort was 73 years. Established cardiovascular disease was present in 25% of patients. Among patients without established CV disease, calculated Framingham risk was high in 65%, intermediate in 33%, and low in 1%. Baseline hypertension was present in 58% of patients, dyslipidemia in 51%, and diabetes or impaired glucose tolerance in 24%. Hypertension was more prevalent in the study cohort than in an age- and sex-matched population sample (OR 1.74, P=0.006; diabetes had a similar prevalence (OR 0.93, P=0.8. Conclusions. Patients receiving ADT have a high prevalence of cardiovascular disease and risk factors and are more likely to be hypertensive than population controls. Low rates of CV risk screening suggest opportunities for improved primary and secondary prevention of CV disease in this population.

  19. Mitochondrial Transcription Factors TFA, TFB1 and TFB2: A Search for DNA Variants/Haplotypes and the Risk of Cardiac Hypertrophy

    Cristina Alonso-Montes; Castro, Mónica G.; Julián R. Reguero; Andreas Perrot; Cemil Özcelik; Christian Geier; Posch, Maximilian G.; César Morís; Victoria Alvarez; Marta Ruiz-Ortega; Eliecer Coto


    Mitochondrial transcription factors mtTFA, mtTFB1 and mtTFB2 are required for the replication of mitochondrial DNA (mtDNA), regulating the number of mtDNA copies. Mice with a mtTFA deletion showed a reduced number of mtDNA copies, a reduction in respiratory chain activity, and a characteristic dilated cardiomyopathy. DNA variants in these genes could be involved in the risk for cardiac hypertrophy (HCM). We determined the variation in the TFAM, TFB1M, and TFB2M genes (using SSCA, DHPLC, and d...

  20. Has Microsoft® Left Behind Risk Modeling in Cardiac and Thoracic Surgery?

    Poullis, Mike


    This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical r...

  1. Cardiac fibrillation risk of Taser weapons.

    Leitgeb, Norbert


    The debate on potential health hazards associated with delivering electric discharges to incapacitated subjects, in particular on whether electric discharge weapons are lethal, less lethal or non-lethal, is still controversial. The cardiac fibrillation risks of Taser weapons X26 and X3 have been investigated by measuring the delivered high-tension pulses in dependence on load impedance. Excitation thresholds and sinus-to-Taser conversion factors have been determined by numerical modeling of endocardial, myocardial, and epicardial cells. Detailed quantitative assessment of cardiac electric exposure has been performed by numerical simulation at the normal-weighted anatomical model NORMAN. The impact of anatomical variation has been quantified at an overweight model (Visible Man), both with a spatial resolution of 2 × 2 × 2 mm voxels. Spacing and location of dart electrodes were systematically varied and the worst-case position determined. Based on volume-weighted cardiac exposure assessment, the fibrillation probability of the worst-case hit was determined to 30% (Taser X26) and 9% (Taser X3). The overall risk assessment of Taser application accounting for realistic spatial hit distributions was derived from training sessions of police officers under realistic scenarios and by accounting for the influence of body (over-)weight as well as gender. The analysis of the results showed that the overall fibrillation risk of Taser use is not negligible. It is higher at Taser X26 than at Taser X3 and amounts to about 1% for Europeans with an about 20% higher risk for Asians. Results demonstrate that enhancement as well as further reduction of fibrillation risk depends on responsible use or abuse of Taser weapons. PMID:24776896

  2. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study.

    Vlaar, Alexander P J; Hofstra, Jorrit J; Determann, Rogier M; Veelo, Denise P; Paulus, Frederique; Kulik, Wim; Korevaar, Johanna; de Mol, Bas A; Koopman, Marianne M W; Porcelijn, Leendert; Binnekade, Jan M; Vroom, Margreeth B; Schultz, Marcus J; Juffermans, Nicole P


    Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both antibodies and bioactive lipids that have accumulated during storage of blood have been implicated in TRALI pathogenesis. In a single-center, nested, case-control study, patients were prospectively observed for onset of TRALI according to the consensus definition. Of 668 patients, 16 patients (2.4%) developed TRALI. Patient-related risk factors for onset of TRALI were age and time on the cardiopulmonary bypass. Transfusion-related risk factors were total amount of blood products (odds ratio [OR] = 1.2; 95% confidence interval [CI], 1.03-1.44), number of red blood cells stored more than 14 days (OR = 1.6; 95% CI, 1.04-2.37), total amount of plasma (OR = 1.2; 95% CI, 1.03-1.44), presence of antibodies in donor plasma (OR = 8.8; 95% CI, 1.8-44), and total amount of transfused bioactive lipids (OR = 1.0; 95% CI, 1.00-1.07). When adjusted for patient risk factors, only the presence of antibodies in the associated blood products remained a risk factor for TRALI (OR = 14.2; 95% CI, 1.5-132). In-hospital mortality of TRALI was 13% compared with 0% and 3% in transfused and nontransfused patients, respectively (P < .05). In conclusion, the incidence of TRALI is high in cardiac surgery patients and associated with adverse outcome. Our results suggest that cardiac surgery patients may benefit from exclusion of blood products containing HLA/HNA antibodies. PMID:21325598

  3. Safety and Efficacy of Prophylactic Amiodarone in Preventing Early Junctional Ectopic Tachycardia (JET) in Children After Cardiac Surgery and Determination of Its Risk Factor.

    Amrousy, Doaa El; Elshehaby, Walid; Feky, Wael El; Elshmaa, Nagat S


    Postoperative arrhythmia is a common complication after open heart surgery in children. JET is the most common and dangerous arrhythmia. We aimed to assess safety and efficacy of prophylactic amiodarone in preventing JET in children underwent cardiac surgery and to assess risk factors for JET among our patients. In total, 117 children who underwent cardiac surgery for CHD at Tanta University Hospital from October 2011 to April 2015 were divided in two groups; amiodarone group (65 patients) was given prophylactic amiodarone intraoperatively and placebo group (52 patients). Amiodarone is started as loading dose of 5 mg/kg IV in the operating room after induction of anesthesia and continued for 3 days as continuous infusion 10-15 μg/kg/min. Primary outcome and secondary outcomes of amiodarone administration were reported. We studied pre-, intra- and postoperative factors to determine risk factors for occurrence of JET among these children. Prophylactic amiodarone was found to significantly decrease incidence of postoperative JET from 28.9 % in placebo group to 9.2 % in amiodarone group, and symptomatic JET from 11.5 % in placebo group to 3.1 % in amiodarone group, and shorten postoperative intensive care unit and hospital stay without significant side effects. Risk factors for occurrence of JET were younger age, lower body weight, longer cardiopulmonary bypass, aortic cross-clamp time, hypokalemia, hypomagnesemia, acidosis and high dose of inotropes. JET was more associated with surgical repair of right ventricular outlet obstruction as in case of tetralogy of Fallot and pulmonary stenosis. Most of JET 15/21 (71.4 %) occurred in the first day postoperatively, and 6/21 occurred in the second day (28.6 %). Prophylactic amiodarone is safe and effective in preventing early JET in children after open heart surgery. PMID:26818850

  4. COMT-Val158Met-Polymorphism Is Not a Risk Factor for Acute Kidney Injury after Cardiac Surgery

    Matthias Kornek; Marcus-André Deutsch; Stefan Eichhorn; Harald Lahm; Stefan Wagenpfeil; Markus Krane; Ruediger Lange; Johannes Boehm


    Background. Cardiac surgery-associated acute kidney injury (CSA-AKI) depicts a major complication after cardiac surgery using cardiopulmonary bypass (CPB). Objective. CSA-AKI has clearly been linked to increased perioperative morbidity and mortality. Dysregulations of vasomotor tone are assumed to be causal for CSA-AKI. While catechol-O-methyltransferase (COMT) is involved in metabolizing catecholamines, a single-nucleotide polymorphism (SNP) in the COMT gene leads to different enzyme activit...

  5. Premature Cardiac Contractions and Risk of Incident Ischemic Stroke

    Ofoma, Uchenna; He, Fan; Michele L. Shaffer; Naccarelli, Gerard V.; Liao, Duanping


    Background The etiologies of ischemic stroke remain undetermined in 15% to 40% of patients. Apart from atrial fibrillation, other arrhythmias are less well-characterized as risk factors. Premature cardiac contractions are known to confer long-term cardiovascular risks, like myocardial infarction. Ischemic stroke as cardiovascular risk outcome remains a topic of interest. We examined the prospective relationships in the Atherosclerosis Risk in Communities (ARIC) study, to determine whether pre...

  6. Phosphate excretion is decreased in older cardiac patients with normal kidney function: an emerging dietary risk factor?

    Jozefacki, Alexis; White, Christine A; Shobeiri, Navid S; Hopman, Wilma M; Johri, Amer M; Adams, Michael A; Holden, Rachel M


    Serum phosphate independently predicts cardiovascular events and mortality. Sixteen healthy adults and 9 adults with cardiovascular disease (CVD) ingested 500 mg of sodium phosphate after an over-night fast. In control subjects, the urine phosphate/creatinine ratio was significantly higher at 2 h (3.12 ± 1.02) than at baseline (1.98 ± 0.58, p CVD patients. Decreased postprandial urinary excretion of phosphate could accelerate vascular calcification and may be an under-recognized risk factor for CVD. PMID:26944224

  7. Prediction of cardiac risk in patients undergoing vascular surgery

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.


    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  8. Motivational factors of adherence to cardiac rehabilitation

    Shahsavari, Hooman; Shahriari, Mohsen; Alimohammadi, Nasrollah


    Background: Main suggested theories about patients’ adherence to treatment regimens recognize the importance of motivation in positive changes in behaviors. Since cardiac diseases are chronic and common, cardiac rehabilitation as an effective prevention program is crucial in management of these diseases. There is always concern about the patients’ adherence to cardiac rehabilitation. The aim of this study was to describe the motivational factors affecting the patients’ participation and compl...

  9. Growth factor-induced mobilization of cardiac progenitor cells reduces the risk of arrhythmias, in a rat model of chronic myocardial infarction.

    Leonardo Bocchi

    Full Text Available Heart repair by stem cell treatment may involve life-threatening arrhythmias. Cardiac progenitor cells (CPCs appear best suited for reconstituting lost myocardium without posing arrhythmic risks, being commissioned towards cardiac phenotype. In this study we tested the hypothesis that mobilization of CPCs through locally delivered Hepatocyte Growth Factor and Insulin-Like Growth Factor-1 to heal chronic myocardial infarction (MI, lowers the proneness to arrhythmias. We used 133 adult male Wistar rats either with one-month old MI and treated with growth factors (GFs, n = 60 or vehicle (V, n = 55, or sham operated (n = 18. In selected groups of animals, prior to and two weeks after GF/V delivery, we evaluated stress-induced ventricular arrhythmias by telemetry-ECG, cardiac mechanics by echocardiography, and ventricular excitability, conduction velocity and refractoriness by epicardial multiple-lead recording. Invasive hemodynamic measurements were performed before sacrifice and eventually the hearts were subjected to anatomical, morphometric, immunohistochemical, and molecular biology analyses. When compared with untreated MI, GFs decreased stress-induced arrhythmias and concurrently prolonged the effective refractory period (ERP without affecting neither the duration of ventricular repolarization, as suggested by measurements of QTc interval and mRNA levels for K-channel α-subunits Kv4.2 and Kv4.3, nor the dispersion of refractoriness. Further, markers of cardiomyocyte reactive hypertrophy, including mRNA levels for K-channel α-subunit Kv1.4 and β-subunit KChIP2, interstitial fibrosis and negative structural remodeling were significantly reduced in peri-infarcted/remote ventricular myocardium. Finally, analyses of BrdU incorporation and distribution of connexin43 and N-cadherin indicated that cytokines generated new vessels and electromechanically-connected myocytes and abolished the correlation of infarct size with deterioration

  10. Diet, nutrition and cardiac risk factor profile of tribal migrant population in an urban slum in India

    Jagajeevan Babu Geddam


    Full Text Available Migration of tribal population to urban areas may increase the risk of non-communicable chronic diseases. In this study an attempt was made to explore the risk factors influencing cardio vascular disease, hypertension and Type 2 diabetes among the tribal migrants living in urban areas. A population based cross sectional study was carried out on tribal migrants (n=138 men, n=137 women aged ≥30 years of low economic status, living in an urban slum (Kondapur of Hyderabad, Telangana, India.  Blood lipids, glucose, homocysteine, glycated Haemoglobin, blood pressure and nutritional biochemical markers such as serum albumin, serum protein, Vitamin-D and haemoglobin were examined in a subsample of tribal migrants. The prevalence of overweight in men and women was 35.3% and 32.4% while general obesity was 14.3% and 24.3% respectively. In addition, high concentration of total cholesterol, low density lipo proteins (LDL, triglycerides, homocysteine and glycosylated haemoglobin in the study population was also observed.  Duration of stay had no significant association with overweight and obesity. Majority of tribal migrants did not meet at least 50% of RDI of micro-nutrients such as iron (80-84%, vitamin A (81-83% and riboflavin (67-84%. Similar finding was observed with food groups such as leafy vegetables (84-91%, milk and milk products. However, the consumption of fat and protein was found to be ≥70% of RDA indicating transition in diet pattern. The present study shows urban life style and diets may predispose to higher incidence of diabetes, hypertension and atherosclerotic cardiovascular disease among tribal migrants living in urban areas.

  11. Cardiac factors in orthostatic hypotension

    Löllgen, H.; Dirschedl, P.; Koppenhagen, K.; Klein, K. E.

    Cardiac function is determined by preload, afterload, heart rate and contractility. During orthostatic stress, the footward blood shift is compensated for by an increase of afterload. LBNP is widely used to analyze effects of volume displacement during orthostatic stress. Comparisons of invasive ( right heart catheterization) and non-invasive approach (echocardiography) yielded similar changes. Preload and afterload change with graded LBNP, heart rate increases, and stroke volume and cardiac output decrease. Thus, the working point on the left ventricular function curve is shifted to the left and downward, similar to hypovolemia. However, position on the Frank-Starling curve, the unchanged ejection fraction, and the constant Vcf indicate a normal contractile state during LBNP. A decrease of arterial oxygen partial pressure during LBNP shwos impaired ventilation/perfusion ratio. Finally, LBNP induced cardiac and hemodynamic changes can be effectively countermeasured by dihydroergotamine, a potent venoconstrictor. Comparison of floating catheter data with that of echocardiography resulted in close correlation for cardiac output and stroke volume. In addition, cardiac dimensions changed in a similar way during LBNP. From our findings, echocardiography as a non-invasive procedure can reliably used in LBNP and orthostatic stress tests. Some informations can be obtained on borderline values indicating collaps or orthostatic syncope. Early fainters can be differentiated from late fainters by stroke volume changes.

  12. Rest perfusion abnormalities in hypertrophic cardiomyopathy: correlation with myocardial fibrosis and risk factors for sudden cardiac death

    Aim: To measure the prevalence of abnormal rest perfusion in a population of consecutive patients with known hypertrophic cardiomyopathy (HCM) referred for cardiovascular MRI (CMR), and to assess any associations between abnormal rest perfusion and the presence, pattern, and severity of myocardial scar and the presence of risk factors for sudden death. Materials and methods: Eighty consecutive patients with known HCM referred for CMR underwent functional imaging, rest first-pass perfusion, and late gadolinium enhancement (LGE). Results: Thirty percent of the patients had abnormal rest perfusion, all of them corresponding to areas of mid-myocardial LGE and to a higher degree of segmental hypertrophy. Rest perfusion abnormalities correlated with more extensive and confluent LGE. The subgroup of patients with myocardial fibrosis and rest perfusion abnormalities (fibrosis+/perfusion+) had more than twice the incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring in comparison to patients with myocardial fibrosis and normal rest perfusion (fibrosis+/perfusion–) and patients with no fibrosis and normal rest perfusion (fibrosis–/perfusion–). Conclusions: First-pass perfusion CMR identifies abnormal rest perfusion in a significant proportion of patients with HCM. These abnormalities are associated with the presence and distribution of myocardial scar and the degree of hypertrophy. Rest perfusion abnormalities identify patients with increased incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring, independently from the presence of myocardial fibrosis. - Highlights: • 30% of patients with HCM have perfusion abnormalities related to scar. • No rest perfusion abnormalities were observed in areas of viable myocardium. • Scar-related perfusion abnormalities were associated with the incidence of NSVT

  13. Risk factors.

    Robbins, Catherine J; Connors, K C; Sheehan, Timothy J; Vaughan, James S


    Minimize surprises on your financial statement by adopting a model for integrated risk management that: Examines interrelationships among operations, investments, and financing. Incorporates concepts of the capital asset pricing model to manage unexpected volatility PMID:17240669

  14. Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients With Diffuse Coronary Atherosclerosis and Low-Risk Factors.

    Magnoni, Marco; Masson, Serge; Andreini, Daniele; Moccetti, Tiziano; Modena, Maria Grazia; Canestrari, Mauro; Berti, Sergio; Casolo, Giancarlo; Gabrielli, Domenico; Marraccini, Paolo; Pontone, Gianluca; Latini, Roberto; Maggioni, Aldo Pietro; Maseri, Attilio


    Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ≥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p 6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden. PMID:26976791

  15. Analysis of the risk factors for post-operative respiratory failure in elderly cardiac carcinoma patients%高龄贲门癌患者术后呼吸衰竭的危险因素分析

    张立凡; 许怀宏; 扬敏杰; 张辉标


    Objective To analyze the risk factors of post-operative respiratory failure in elderly cardiac carcinoma patients.Methods 28 elderly patients with respiratory failure (respiratory failure group) after the resection of cardiac carcinoma and 56 controls (control group) were studied.Preoperative respiratory function,the other complications,the site of incision,intravenous infusion,age of patients and smoking between two groups were compared by Logistic regression.Results Univariate risk factors included MVV50% ,FEV150% ,FEV,50%、第一秒用力呼气容积(FEV1)50%、FEV1<1.5 L、DLCO<80%是术后发生RF的危险因素.结论术前肺功能检查可预测术后RF的发生,也可采取预防措施减少RF的发生.

  16. Endometrial Cancer Risk Factors

    ... cancer? Next Topic What causes endometrial cancer? Endometrial cancer risk factors A risk factor is anything that affects your ... to obesity, which is a well-known endometrial cancer risk factor. Many scientists think this is the main way ...

  17. Risk Factors and Prevention

    ... Resources Risk Factors & Prevention Back to Patient Resources Risk Factors & Prevention Even people who look healthy and ... Blood Pressure , high cholesterol, diabetes, and thyroid disease. Risk Factors For Arrhythmias and Heart Disease The following ...

  18. Risk Factors for Scleroderma

    ... You are here: Home For Patients Risk Factors Risk Factors for Scleroderma The cause of scleroderma is ... what biological factors contribute to scleroderma pathogenesis. Genetic Risk Scleroderma does not tend to run in families ...

  19. Predicting the risk of sudden cardiac death.

    Lerma, Claudia; Glass, Leon


    Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology. PMID:26660287

  20. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7±10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6±5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery

  1. Factors influencing the cardiac MIBG accumulation

    Following factors possibly influencing the cardiac MIBG accumulation were examined mainly in mice. 1. The specific activity of the MIBG (meta-iodo-benzyl guanidine) on the neuronal and non-neuronal fractions. 2. Motor restriction stress on MIBG accumulation and washout. 3. Loading and restriction of sodium chloride on the accumulation and effect of suppression of renin-angiotensin system. 4. Examinations in Dahl rats. 125I- or 131I-MIBG was intravenously administered to mice at 74 kBq. At 30 min or 4 hr after administration, mice were sacrificed and their left ventricles were dissected out for measurement of radioactivity in a liquid scintillation counter. Salt-sensitive and -resistant Dahl rats were given with 37 MBq of 123I-MIBG and cardiac radioactivity was measured externally for calculation of washout. Factors examined were found highly correlated with the accumulation of MIBG and measurement of its washout was considered useful for evaluating sympathetic activity. (K.H.)

  2. Factor analysis in gated cardiac studies

    Factor analysis of dynamic structures (FADS) can automatically provide ''physiological'' factors related to anatomical structures that have different temporal behavior, even if these structures overlap; it also yields images corresponding to the factors' spatial distributions. FADS has been applied to 45 gated cardiac studies. Results obtained by FADS were compared with those obtained from the amplitude and the phase of first-harmonic Fourier analysis (FA). The joint results were compared with the final diagnosis, established by real-time echocardiography and/or ventriculography. In normal patients, good agreement was obtained between the two approaches. On the whole set of patients, FADS was significantly better than FA

  3. Risk stratification systems in cardiac surgery

    G. Tinică


    Full Text Available n medicine, as in any other field, quality is a prerequisite of competitiveness. In this paper we do a brief description and definition of commonly used preoperative risk scores for heart surgery with regard to their predictive values and clinical applicability for current population. Although most of the selected score systems were primarily designed to predict mortality, postoperative morbidity has been acknowledged as the major determinant of hospital cost and quality of life after surgery. Any method of evaluation and optimization of quality is based on a risk stratification system. Risk system development and their application in current medical practice have become increasingly popular in the recent years because of the many therapeutic options available for some cardiovascular diseases, which until now were considered difficult to address, due to technical advances that are enabling risk taking. Risk stratification is a powerful decision-making tool and should represent an incumbent part of the cardiac surgical practice, just like the knowledge of anatomy and the practice of surgical techniques. These models also play an increasingly important role in risk management and performance measurement processes like quality analysis, meaningful comparison of outcomes, and identifying the optimal relationship between cost, quality of medical care and efficiency.

  4. Heart disease - risk factors

    ... this page: // Heart disease - risk factors To use the sharing features on ... a certain health condition. Some risk factors for heart disease you cannot change, but some you can. Changing ...

  5. Risk Factors and interventions for bloodstream infections after cardiac interventional therapy%心脏介入术后血管相关性血流感染因素分析及干预对策

    赵雪芳; 狄韵漫


    目的 探讨心脏介入手术后发生中心静脉相关性血流感染因素及干预对策.方法 对心脏介入手术患者进行目标性临测及导管室的管理监控,分析、干预和总结感染因素.结果 通过开展目标性监测及干预对策,中心静脉导管相关性血流感染的感染率由开展前的1.9%下降为0,差异有统计学意义(P<0.01).结论 加强导管室管理,对介入手术进行监测和感染因素的干预,是预防心脏介入手术发生中心静脉导管相关性血流感染的有效方法.%OBJECTIVE To explore risk factors and intervention countermeasures for central venous catheter-related bloodstream infections after cardiac interventional therapy. METHODS By carrying out targeted surveillance in cardiac interventional therapy and monitoring of catheterization lab, the risk factors for the infections were analyzed, intervened, and summarized. RESULTS The incidence of the central venous catheter-related infections dropped from 1. 9% to 0 after the targeted surveillance and intervention countermeasures, and the difference was statistically significant (P<0. 01). CONCLUSION To strengthen the management of cauterization lab, monitor the interventional surgery, and intervene in the risk factors are effective ways to prevent central venous catheter-related bloodstream infections after cardiac interventional therapy.

  6. Cerebrovascular Risk Factors - In View of Stroke Prevention

    Schreiber, Angela K.; Haberl, Roman L.


    Stroke risk factors can be divided into those with evidence-based relationship and those with supposed relationship to ischemic stroke, and into potentially treatable risk factors and risk factors with no therapeutic options. Age, gender and race are risk factors with no therapeutic options, while among treatable stroke risk factors most important are high blood pressure, atrial fibrillation, patent foramen ovale, cardiac disorders, diabetes mellitus, hiperhomocysteinemia, hiperlipidemia, and...

  7. Potential risk factors for surgical site infection after isolated coronary artery bypass grafting in a Bahrain Cardiac Centre: A retrospective, case-controlled study

    Ahmed Abdulaziz Abuzaid


    Conclusions: Patients with comorbidities of impaired renal function and/or impaired left ventricular systolic function are at high risk of developing SSI. There appears to be a relationship between SSIs in CABG patients and impaired renal or LV function (low ejection fraction. CABG with BIMA grafting could be performed safely even in diabetics. Future studies should consider further scrutiny of these and other factors in relation to SSIs in a larger surgical population.

  8. Cardiac rehabilitation with a nurse case manager (GoHeart) across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study

    Hansen, Vibeke Brogaard; Maindal, Helle Terkildsen


    .01), self-care management (p < 0.001), Health status Short Form 12 version (SF12; physical; p < 0.001 and mental; p < 0.01) and in depression symptoms (p < 0.01). At one-year follow-up these outcomes were maintained; additionally there was improvement in body mass index (BMI; p < 0.05), and high density......%). MAIN OUTCOME MEASURES: Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention-to-treat and...

  9. Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols

    Anne Kastelianne França da Silva; Marianne Penachini da Costa de Rezende Barbosa; Aline Fernanda Barbosa Bernardo; Franciele Marques Vanderlei; Francis Lopes Pacagnelli; Luiz Carlos Marques Vanderlei


    Objective: Gather and describe general characteristics of different protocols of risk stratification for cardiac patients undergoing exercise. Methods: We conducted searches in LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO electronic databases, using the following descriptors: Cardiovascular Disease, Rehabilitation Centers, Practice Guideline, Exercise and Risk Stratification in the past 20 years. Results: Were selected eight studies addressing methods of risk stratification i...

  10. Athletes at Risk for Sudden Cardiac Death

    Subasic, Kim


    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  11. Pancreatic Cancer Risk Factors

    ... factors can affect a person’s chance of getting cancer of the pancreas. Most of these are risk factors for exocrine ... Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer (especially in smokers), but most people with pancreatitis ...

  12. Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation

    Ana A. S. Santos


    Full Text Available ABSTRACT Background Cardiac risk stratification is related to the risk of the occurrence of events induced by exercise. Despite the existence of several protocols to calculate risk stratification, studies indicating that there is similarity between these protocols are still unknown. Objective To evaluate the agreement between the existing protocols on cardiac risk rating in cardiac patients. Method The records of 50 patients from a cardiac rehabilitation program were analyzed, from which the following information was extracted: age, sex, weight, height, clinical diagnosis, medical history, risk factors, associated diseases, and the results from the most recent laboratory and complementary tests performed. This information was used for risk stratification of the patients in the protocols of the American College of Sports Medicine, the Brazilian Society of Cardiology, the American Heart Association, the protocol designed by Frederic J. Pashkow, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Société Française de Cardiologie, and the Sociedad Española de Cardiología. Descriptive statistics were used to characterize the sample and the analysis of agreement between the protocols was calculated using the Kappa coefficient. Differences were considered with a significance level of 5%. Results Of the 21 analyses of agreement, 12 were considered significant between the protocols used for risk classification, with nine classified as moderate and three as low. No agreements were classified as excellent. Different proportions were observed in each risk category, with significant differences between the protocols for all risk categories. Conclusion The agreements between the protocols were considered low and moderate and the risk proportions differed between protocols.

  13. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Thomas M Hemmerling


    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  14. Risk factors for neoplasms

    A broad survey is given of risk factors for neoplasms. The main carcinogenic substances (including also ionizing radiation and air pollution) are listed, and are correlated with the risk factors for various cancers most frequently explained and discussed in the literature. The study is intended to serve as a basis for a general assessment of the incidence of neoplasms in children, and of cancer mortality in the entire population of Bavaria in the years 1983-1989, or 1979-1988, respectively, with the principal idea of drawing up an environment-related health survey. The study therefore takes into account not only ionizing radiation as a main risk factor, but also other risk factors detectable within the ecologic context, as e.g. industrial installations and their effects, refuse incineration plants or waste dumps, or the social status. (orig./MG)

  15. Brain Tumor Risk Factors

    ... for example), unusual symptoms such as headaches or short-term memory loss can be investigated with your family history in mind. Click here to view our webinars on Causes and Risk Factors of Brain Tumors. Additional information ...

  16. Risk Factors of Cholangiocarcinoma

    Tyson, Gia L.; El-Serag, Hashem B.


    Cholangiocarcinoma is the second most common primary hepatic malignancy after hepatocellular cancer. It accounts for approximately 10–25% of all hepatobiliary malignancies. There are considerable geographic and demographic variations in the incidence of cholangiocarcinoma. There are several established risk factors for CC including parasitic infections, primary sclerosing cholangitis, biliary-duct cysts, hepatolithiasis, and toxins. Other less-established, potential risk factors include infla...

  17. Long-Term Exercise and Risk of Metabolic and Cardiac Diseases: The Erlangen Fitness and Prevention Study

    Kemmler, Wolfgang; von Stengel, Simon; Bebenek, Michael; Kalender, Willi A.


    In female subjects, ageing and the menopausal transition contribute to a rapid increase of metabolic and cardiac risk factors. Exercise may be an option to positively impact various risk factors prone to severe metabolic and cardiac diseases and events. This study was conducted to determine the long-term effect of a multipurpose exercise program on metabolic and cardiac risk scores in postmenopausal women. 137 osteopenic Caucasian females (55.4 ± 3.2 yrs), 1–8 years postmenopausal, were inclu...

  18. Cardiac fibrillation risks with TASER conducted electrical weapons.

    Panescu, Dorin; Kroll, Mark; Brave, Michael


    The TASER(®) conducted electrical weapon (CEW) delivers electrical pulses that can temporarily incapacitate subjects. We analyzed the cardiac fibrillation risk with TASER CEWs. Our risk model accounted for realistic body mass index distributions, used a new model of effects of partial or oblique dart penetration and used recent epidemiological CEW statics. PMID:26736265

  19. Perioperative evaluation of cardiac surgical risk: particularities in the emergency surgery – from the guidelines to the clinical practice

    Andronescu, AM; Nechita, AC; Ittu, G; Delcea, C; Dumitrescu, G; Vintila, MM


    Rationale: Cardiac risk in patients undergoing surgery depends on many factors from the patient's cardiovascular history to the surgical procedure itself, with its particularities, the type of anesthesia, fluid exchanges and the supervision of the patient. Therefore, this risk must be carefully considered and it determines the endorsement of perioperative measures with important medical implications. Objective: Perioperative cardiac risk evaluation guidelines were published since 2010 and the...

  20. Clinically Significant Contrast Induced Acute Kidney Injury after Non-Emergent Cardiac Catheterization - Risk Factors and Impact on Length of Hospital Stay

    Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy (CIN) in patients undergoing non-emergent coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of >= 1.5 mg/dl at the time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure. Results: One hundred and sixteen patients met the inclusion criteria. Mean age was 64.0 +- 11.5 years, 72% were males. Overall prevalence of CIN was 17% (rise of serum creatinine by A= 0.5 mg/dl) while that of clinically significant CIN (CSCIN) was 9.5% (11 patients). Patients with CSCIN had significantly lower left ventricular ejection fraction (p = 0.03, OR: 0.24; 95% CI = 0.06 A= 0.91) and higher prevalence of cerebrovascular disease (p < 0.001, OR: 14.66; 95% CI = 3.30 - 65.08). Mean baseline serum creatinine was significantly higher, 3.0 +- 1.5 vs. 2.0 +- 1.1 mg/dl (p = 0.03, OR: 1.47; 95% CI = 1.03 - 2.11) whereas mean GFR estimated by Cockcroft-Gault formula was significantly lower at 25 +- 7.4 vs. 41.0 +- 14.6 ml/minute (p = 0.001, OR = 0.89, 95% CI = 0.84 A= 0.95) at the time of procedure in patients with CSCIN. Mean length of hospital stay was significantly higher in this group compared to those without CIN, 9.0 +- 5.1 vs. 3.0 +- 3.2 days (p = 0.001, OR = 1.31, 95% CI = 1.12 - 1.54). Multivariate analysis revealed low GFR (p = 0.001, OR = 0.88; 95% CI = 0.82 - 0.95) and low ejection fraction (p = 0.03, OR = 0.20; 95% CI = 0.04 - 0.91) to be independent factors associated with CSCIN. No significant differences were noted between the two groups in patients with

  1. The cardiac safety of aripiprazole treatment in patients at high risk for torsade

    Polcwiartek, Christoffer; Sneider, Benjamin; Graff, Claus;


    reviewed and cardiac safety data were extracted. Continuous and dichotomous QTc data were used in the meta-analysis. RESULTS: Preclinical studies suggested that aripiprazole has limited affinity for the delayed rectifier potassium current. TdP was reported in two case reports and SCD was reported in one...... case report and one case series. No clinical studies assessing aripiprazole's cardiac safety in patients at high risk for torsade were found. No thorough QT (TQT) study with aripiprazole was found. The meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole and QTc...... factors. OBJECTIVES: Aripiprazole's cardiac safety has not been assessed in patients at high risk for torsade, where QTc prolongation risk is highly increased. METHODS: MEDLINE, Embase, and The Cochrane Library were searched for preclinical, clinical, and epidemiological studies. Eligible studies were...

  2. Heart Disease Risk Factors

    ... Hearts® WISEWOMAN Program Other Chronic Disease Topics Diabetes Nutrition Obesity Physical Activity Stroke Heart Disease Risk Factors Recommend ... Hearts® WISEWOMAN Program Other Chronic Disease Topics Diabetes Nutrition Obesity Physical Activity Stroke File Formats Help: How do ...

  3. Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study

    Knudtson Merril L


    Full Text Available Abstract Background Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival. Methods We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294 attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG surgery, percutaneous coronary intervention (PCI, and survival (to December 2005. Results 2827 patients (45% were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p Conclusion These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

  4. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser;


    BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use....... METHODS: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes...... with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs. RESULTS...

  5. Breast cancer risk factors.

    Kamińska, Marzena; Ciszewski, Tomasz; Łopacka-Szatan, Karolina; Miotła, Paweł; Starosławska, Elżbieta


    Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women's ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neoplasm. Taking the possibility of influencing the neoplastic transformation process in individuals as a criterion, all the risk factors initiating the process can be divided into two groups. The first group would include inherent factors such as age, sex, race, genetic makeup promoting familial occurrence of the neoplastic disease or the occurrence of benign proliferative lesions of the mammary gland. They all constitute independent parameters and do not undergo simple modification in the course of an individual's life. The second group would include extrinsic factors conditioned by lifestyle, diet or long-term medical intervention such as using oral hormonal contraceptives or hormonal replacement therapy and their influence on the neoplastic process may be modified to a certain degree. Identification of modifiable factors may contribute to development of prevention strategies decreasing breast cancer incidence. PMID:26528110

  6. Breast cancer risk factors

    Marzena Kamińska


    Full Text Available Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women’s ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neoplasm. Taking the possibility of influencing the neoplastic transformation process in individuals as a criterion, all the risk factors initiating the process can be divided into two groups. The first group would include inherent factors such as age, sex, race, genetic makeup promoting familial occurrence of the neoplastic disease or the occurrence of benign proliferative lesions of the mammary gland. They all constitute independent parameters and do not undergo simple modification in the course of an individual’s life. The second group would include extrinsic factors conditioned by lifestyle, diet or long-term medical intervention such as using oral hormonal contraceptives or hormonal replacement therapy and their influence on the neoplastic process may be modified to a certain degree. Identification of modifiable factors may contribute to development of prevention strategies decreasing breast cancer incidence.

  7. Breast cancer risk factors

    Marzena Kamińska; Tomasz Ciszewski; Karolina Łopacka-Szatan; Paweł Miotła; Elżbieta Starosławska


    Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women's ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neopla...

  8. Neonatal Stroke : Risk Factors


    Neonatal stroke refers to cerebrovascular events between 28 weeks of gestational age and 28 days postnatal and includes thromboembolic cerebral infarction and all kinds of intracranial haemorrhage. Neonatal stroke may contribute to severe neurological deficit, such as cerebral palsy and even death. International reports suggest the incidence to be approximately 1/4000 live births per year (1). There are several etiological hypothesises regarding risk factors, such as maternal, obstetrical...

  9. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study


    Background Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6–12 months post-event, in central Australia. Methods This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients’ “typical” journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. Results Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Conclusion Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented

  10. Cardiac risk stratification in cardiac rehabilitation programs: a review of protocols

    Anne Kastelianne França da Silva


    Full Text Available Objective: Gather and describe general characteristics of different protocols of risk stratification for cardiac patients undergoing exercise. Methods: We conducted searches in LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO electronic databases, using the following descriptors: Cardiovascular Disease, Rehabilitation Centers, Practice Guideline, Exercise and Risk Stratification in the past 20 years. Results: Were selected eight studies addressing methods of risk stratification in patients undergoing exercise. Conclusion: None of the methods described could cover every situation the patient can be subjected to; however, they are essential to exercise prescription.

  11. Etiologic factors of gastric cardiac adenocarcinoma among men in Taiwan

    Mei-Ju Chen; Deng-Chyang Wu; Jia-Ming Lin; Ming-Tsang Wu; Fung-Chang Sung


    AIM: To elucidate etiologic associations between Helicobacter pylori ( H pylori), lifestyle, environmental factors and gastric cardiac adenocarcinoma (GCA) among men.METHODS: A hospital-based case-control study was conducted in Taiwan from 2000 to 2009.All cases were newly confirmed as primary GCA.Five controls were selected matching with age, sex, and admission date to each case.Participants were informed of potential risk factors with a structured questionnaire by trained interviewers during hospitalization and provided a blood sample for the determination of H pylori infection.Odds ratio (OR) and 95% confidence interval (95% CI) were used to evaluate risk, and a multivariate conditional logistic regression model was performed.RESULTS: All participants recruited for this study were men, consisting of 41 cases and 205 controls.Results of the univariate analysis showed that significant factors associated with the etiology of GCA included H pylori (OR = 2.69, 95% CI = 1.30-5.53), cigarette smoking (OR = 2.28, 95% CI = 1.05-4.96), working or exercising after meals (OR = 3.26, 95% CI = 1.31-8.11), salted food (OR = 2.51, 95%CI = 1.08-6.11), fresh vegetables (OR = 0.28, 95% CI = 0.09-0.80), fruits (OR = 0.19, 95% CI = 0.04-0.89), and rice as principal food (OR = 0.53, 95% CI = 0.30-0.85).Multivariate conditional logistic regression models indicated that a significantly elevated risk of contracting GCA was associated with working or exercising after meals (OR = 3.18, 95% CI = 1.23-9.36) and H pylori infection (OR = 2.93, 95% CI = 1.42-6.01).In contrast, the consumption of fresh vegetables (OR = 0.22, 95% CI = 0.06-0.83), fruits (OR = 0.28, 95% CI = 0.09-0.79) and rice as principal food (OR = 0.48, 95% CI = 0.24-0.93) remained as significant beneficial factor associated with GCA.CONCLUSION: Working or exercising after meals and H pylori infection increase the risk of GCA, but higher intakes of rice, fresh vegetables and fruits reduce the risk.

  12. Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men

    Daskalopoulou, M.; George, J.; Walters, K.; Osborn, D. P.; Batty, G D; Stogiannis, D.; Rapsomaniki, E.; Pujades-Rodriguez, M.; Denaxas, S.; Udumyan, R.; Kivimaki, M.; Hemingway, H


    BACKGROUND: Depression is associated with coronary heart disease and stroke, but associations with a range of pathologically diverse cardiovascular diseases are not well understood. We examine the risk of 12 cardiovascular diseases according to depression status (history or new onset). METHODS: Cohort study of 1,937,360 adult men and women, free from cardiovascular disease at baseline, using linked UK electronic health records between 1997 and 2010. The exposures were new-onset depression (a ...

  13. Risk Factors for Eating Disorders

    Striegel-Moore, Ruth H.; Bulik, Cynthia M.


    The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances…




    Full Text Available Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for c erebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Re sults: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension followed by smoking, diabetes mellitus. More common pathology was infarction. Conclusion: Com mon risk factors for acute stroke are hypertension, smoking, diabetes mellitus, alcoholism, obesity, cardiac disease. Stroke was confirmed by CT scan of brain.

  15. Risk Parity Portfolios with Risk Factors

    Roncalli, Thierry; Weisang, Guillaume


    Portfolio construction and risk budgeting are the focus of many studies by academics and practitioners. In particular, diversification has spawn much interest and has been defined very differently. In this paper, we analyze a method to achieve portfolio diversification based on the decomposition of the portfolio's risk into risk factor contributions. First, we expose the relationship between risk factor and asset contributions. Secondly, we formulate the diversification problem in terms of ri...

  16. QTc interval in the assessment of cardiac risk

    Elming, Hanne; Brendorp, Bente; Køber, Lars; Sahebzadah, Najia; Torp-Petersen, Christian


    with increased risk of arrhythmias. The paper gives a review of the possibilities to assess the risk of ventricular arrhythmia and/or cardiac death from QTc. Prolonged QTc may hold independent prognostic importance for mortality in common diseases as ischemic heart disease and diabetes mellitus where...... prognostic importance in hypertrophic cardiomyopathy or in the arrhythmogenic right ventricular disease. The degree of QTc prolonging during treatment with QTc prolonging drugs is prognostic for the risk of ventricular arrhythmia in form of torsade de pointes and QTc prolonging drugs should probably not be...

  17. Predicted risks of radiogenic cardiac toxicity in two pediatric patients undergoing photon or proton radiotherapy

    Hodgkin disease (HD) and medulloblastoma (MB) are common malignancies found in children and young adults, and radiotherapy is part of the standard treatment. It was reported that these patients who received radiation therapy have an increased risk of cardiovascular late effects. We compared the predicted risk of developing radiogenic cardiac toxicity after photon versus proton radiotherapies for a pediatric patient with HD and a pediatric patient with MB. In the treatment plans, each patient’s heart was contoured in fine detail, including substructures of the pericardium and myocardium. Risk calculations took into account both therapeutic and stray radiation doses. We calculated the relative risk (RR) of cardiac toxicity using a linear risk model and the normal tissue complication probability (NTCP) values using relative seriality and Lyman models. Uncertainty analyses were also performed. The RR values of cardiac toxicity for the HD patient were 7.27 (proton) and 8.37 (photon), respectively; the RR values for the MB patient were 1.28 (proton) and 8.39 (photon), respectively. The predicted NTCP values for the HD patient were 2.17% (proton) and 2.67% (photon) for the myocardium, and were 2.11% (proton) and 1.92% (photon) for the whole heart. The predicted ratios of NTCP values (proton/photon) for the MB patient were much less than unity. Uncertainty analyses revealed that the predicted ratio of risk between proton and photon therapies was sensitive to uncertainties in the NTCP model parameters and the mean radiation weighting factor for neutrons, but was not sensitive to heart structure contours. The qualitative findings of the study were not sensitive to uncertainties in these factors. We conclude that proton and photon radiotherapies confer similar predicted risks of cardiac toxicity for the HD patient in this study, and that proton therapy reduced the predicted risk for the MB patient in this study

  18. Locally derived system for cardiac operative risk evaluation

    Mihajlović Bogoljub


    Full Text Available Introduction. During the last two decades, many authors have found that European Systems for Cardiac Operative Risk Evaluation (additive and logistic models overestimate the risk in cardiac surgery. The new European model has recently been introduced as an update to previous versions. The aim of the study was to investigate the significance of locally derived system for cardiac operative risk evaluation and to compare its predictive power with the existing European systems. Material and Methods. For developing a local risk prediction model, data from 2681 patients submitted to cardiac surgery at the Institute of Cardiovascular Diseases Vojvodina have thoroughly been collected. Logistic regression analysis was used to construct a local model for prediction of outcome. The evaluation of the local model and three European systems was performed by comparing the observed and expected hospital mortality. Results. The difference between the predicted and observed mortality regardless of the type of surgery was statistically insignificant for the additive European system (p=0.073 and the local model (p=0.134. The logistic European system overestimated the operative risk, while the new European model underestimated mortality. In coronary surgery, all models, except the logistic European system, performed well. In valvular surgery, the new European model and the local model underestimated mortality significantly, while the additive and logistic European models performed well. In combined surgery, the new European system significantly underestimated mortality (p=0.029, while the local model performed well (p=0.252. Conclusion. The locally derived model shows satisfactory results, with good calibration and discriminative power. The local model specifically outperforms all other European systems in terms of discriminatory power in combined surgery subset.

  19. Growth hormone and risk for cardiac tumors in Carney complex.

    Bandettini, W Patricia; Karageorgiadis, Alexander S; Sinaii, Ninet; Rosing, Douglas R; Sachdev, Vandana; Schernthaner-Reiter, Marie Helene; Gourgari, Evgenia; Papadakis, Georgios Z; Keil, Meg F; Lyssikatos, Charalampos; Carney, J Aidan; Arai, Andrew E; Lodish, Maya; Stratakis, Constantine A


    Carney complex (CNC) is a multiple neoplasia syndrome that is caused mostly by PRKAR1A mutations. Cardiac myxomas are the leading cause of mortality in CNC patients who, in addition, often develop growth hormone (GH) excess. We studied patients with CNC, who were observed for over a period of 20 years (1995-2015) for the development of both GH excess and cardiac myxomas. GH secretion was evaluated by standard testing; dedicated cardiovascular imaging was used to detect cardiac abnormalities. Four excised cardiac myxomas were tested for the expression of insulin-like growth factor-1 (IGF-1). A total of 99 CNC patients (97 with a PRKAR1A mutation) were included in the study with a mean age of 25.8 ± 16.6 years at presentation. Over an observed mean follow-up of 25.8 years, 60% of patients with GH excess (n = 46) developed a cardiac myxoma compared with only 36% of those without GH excess (n = 54) (P = 0.016). Overall, patients with GH excess were also more likely to have a tumor vs those with normal GH secretion (OR: 2.78, 95% CI: 1.23-6.29; P = 0.014). IGF-1 mRNA and protein were higher in CNC myxomas than in normal heart tissue. We conclude that the development of cardiac myxomas in CNC may be associated with increased GH secretion, in a manner analogous to the association between fibrous dysplasia and GH excess in McCune-Albright syndrome, a condition similar to CNC. We speculate that treatment of GH excess in patients with CNC may reduce the likelihood of cardiac myxoma formation and/or recurrence of this tumor. PMID:27535175

  20. What Are the Risk Factors?

    ... Links Stay Informed Cancer Home What Are the Risk Factors for Lung Cancer? Language: English Español (Spanish) Recommend ... from your cell phone Research has found several risk factors that may increase your chances of getting lung ...

  1. Risk Factor Assessment Branch (RFAB)

    The Risk Factor Assessment Branch (RFAB) focuses on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.

  2. New insight into epirubicin cardiac toxicity: competing risks analysis of 1097 breast cancer patients

    Ryberg, Marianne; Cortese, Giuliana; Nielsen, Gitte;


    BACKGROUND: Current recommendations that cancer patients receive a maximum cumulative dose of 900 mg/m(2) epirubicin are based on the risk of epirubicin-mediated cardiotoxicity and do not take into account the competing risk of death from cancer. Here, we identify risk factors for cardiotoxicity...... and overall mortality and determine the cumulative dose of epirubicin that yields a 5% risk for cardiotoxicity for cancer patients from different risk backgrounds. METHODS: Data were collected from 1097 consecutive anthracycline-naive patients treated for metastatic breast cancer with epirubicin.......40, 95% confidence interval = 1.21 to 1.61), patient age, predisposition to cardiac disease, history of mediastinal irradiation, or antihormonal treatment for metastatic disease. Risk factors for death from all other causes (including breast cancer) included lesser dosages of epirubicin, increased tumor...

  3. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery.

    Papachristofi, O; Sharples, L D; Mackay, J H; Nashef, S A M; Fletcher, S N; Klein, A A


    It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. PMID:26511481

  4. Risk factors of cerebrovascular diseases and their intervention and management

    En XU; Hai-xia WEN


    Cerebrovascular diseases are important causes of clinical death and disability because of high prevalence and morbidity and easy to recurrence. A number of risk factors have involved in the progress of cerebrovascular diseases, which include uncontrolled and controlled risk factors. The former refers to old age, gender, low birth weight, race/ethnicity, genetic factors, etc. The latter includes hypertension, diabetes mellitus, atrial fibrillation and other cardiac diseases, dyslipidemia...

  5. Preoperative Statin use is not Associated with a Reduced Risk of Atrial Fibrillation After Cardiac Surgery

    Brian J Barnes PharmD


    Full Text Available Introduction Postoperative atrial fibrillation (POAF is prevalent after cardiac surgery and associated with significant morbidity and costs. Statins are commonly used in this population and may be a preventative strategy for PAOF. We wished to examine the effect of preoperative statin use on the risk of POAF after cardiac surgery. Methods A retrospective, observational study was conducted using data from 489 adult patients who underwent cardiac surgery at a single institution. Univariate analyses and unconditional logistic regression were used to determine the impact of preoperative statin use on the probability of developing POAF, while controlling for the baseline risk of POAF and the use of amiodarone prophylaxis (AMP. A baseline risk index was calculated for each patient using a previously validated model. Patients with chronic atrial fibrillation or missing data were excluded. Results Mean patient age was 63 (SD=13 years, 73% were male, 68% underwent isolated coronary artery bypass grafting, 16% underwent isolated valve surgery, with 13% underwent combined CABG and valve surgeries, and 3% underwent other forms of cardiac surgery. POAF occurred in 27% of patients receiving statins and 24% of those not receiving statins (p=0.3792. After controlling for baseline risk of POAF and the use of AMP, we found that preoperative statins were not associated with reductions in POAF (OR=1.19, 95%CI=0.782-1.822, p=0.4118. Conclusions Multiple factors impact the development of POAF after cardiac surgery including patient demographics, comorbidities, surgical type, and concomitant medications. In this study, after adjustment for these factors the preoperative use of statins did not significantly influence the development of POAF.

  6. Stroke - risk factors

    ... Risk of stroke goes up with age. Your gender. Men have a higher risk of getting heart disease than women, except in older adults. Your genes and race. If your parents had a stroke, you are at higher risk. ...

  7. Imminent Cardiac Risk Assessment via Optical Intravascular Biochemical Analysis

    Wetzel, D.; Wetzel, L; Wetzel, M; Lodder, R


    Heart disease is by far the biggest killer in the United States, and type II diabetes, which affects 8% of the U.S. population, is on the rise. In many cases, the acute coronary syndrome and/or sudden cardiac death occurs without warning. Atherosclerosis has known behavioral, genetic and dietary risk factors. However, our laboratory studies with animal models and human post-mortem tissue using FT-IR microspectroscopy reveal the chemical microstructure within arteries and in the arterial walls themselves. These include spectra obtained from the aortas of ApoE-/- knockout mice on sucrose and normal diets showing lipid deposition in the former case. Also pre-aneurysm chemical images of knockout mouse aorta walls, and spectra of plaque excised from a living human patient are shown for comparison. In keeping with the theme of the SPEC 2008 conference Spectroscopic Diagnosis of Disease this paper describes the background and potential value of a new catheter-based system to provide in vivo biochemical analysis of plaque in human coronary arteries. We report the following: (1) results of FT-IR microspectroscopy on animal models of vascular disease to illustrate the localized chemical distinctions between pathological and normal tissue, (2) current diagnostic techniques used for risk assessment of patients with potential unstable coronary syndromes, and (3) the advantages and limitations of each of these techniques illustrated with patent care histories, related in the first person, by the physician coauthors. Note that the physician comments clarify the contribution of each diagnostic technique to imminent cardiac risk assessment in a clinical setting, leading to the appreciation of what localized intravascular chemical analysis can contribute as an add-on diagnostic tool. The quality of medical imaging has improved dramatically since the turn of the century. Among clinical non-invasive diagnostic tools, laboratory tests of body fluids, EKG, and physical examination are

  8. Perinatal risk factors for strabismus

    Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry; Haargaard, Birgitte; Wohlfahrt, Jan; Holmes, Jonathan M; Melbye, Mads


    Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

  9. Regulation of cardiac microRNAs by serum response factor

    Wei Jeanne Y


    Full Text Available Abstract Serum response factor (SRF regulates certain microRNAs that play a role in cardiac and skeletal muscle development. However, the role of SRF in the regulation of microRNA expression and microRNA biogenesis in cardiac hypertrophy has not been well established. In this report, we employed two distinct transgenic mouse models to study the impact of SRF on cardiac microRNA expression and microRNA biogenesis. Cardiac-specific overexpression of SRF (SRF-Tg led to altered expression of a number of microRNAs. Interestingly, downregulation of miR-1, miR-133a and upregulation of miR-21 occurred by 7 days of age in these mice, long before the onset of cardiac hypertrophy, suggesting that SRF overexpression impacted the expression of microRNAs which contribute to cardiac hypertrophy. Reducing cardiac SRF level using the antisense-SRF transgenic approach (Anti-SRF-Tg resulted in the expression of miR-1, miR-133a and miR-21 in the opposite direction. Furthermore, we observed that SRF regulates microRNA biogenesis, specifically the transcription of pri-microRNA, thereby affecting the mature microRNA level. The mir-21 promoter sequence is conserved among mouse, rat and human; one SRF binding site was found to be in the mir-21 proximal promoter region of all three species. The mir-21 gene is regulated by SRF and its cofactors, including myocardin and p49/Strap. Our study demonstrates that the downregulation of miR-1, miR-133a, and upregulation of miR-21 can be reversed by one single upstream regulator, SRF. These results may help to develop novel therapeutic interventions targeting microRNA biogenesis.

  10. Risks factoring business: accounting measurement

    Z.V. Gutsaylyuk


    Full Text Available The paper carried out the identification of risk factors for the development of possible accounting software management. Studied theoretical and methodological aspects of the risk classification of factoring operations in the part of the risk assessment factors. It is proposed to consider the risks factors as the risk that is acceptable controlled by accounting instruments and the risks that can not be taken into account in the accounting records. To minimize the risk factor, accounting-driven tools, a method of self-insurance, which is a factor in the creation of provision for factoring transactions designed to cover unexpected expenses and losses. Provision for factoring factor will establish more stable conditions of financial activity and avoid the fluctuations of profit factor in relation to the writing off of losses on factoring operatsіyam.Developed proposals allow for further research to improve the organizational and methodological basis of accounting and analysis of information as a basis for providing risk management factor, particularly in terms of improving the evaluation questions such risks and their qualitative and quantitative analysis.

  11. Genetic Risk Factors

    Full Text Available ... of Ashkenazi Jewish descent, causes a greatly increased risk of breast cancer. Zora and her relatives who carry the gene also have an increased risk of ovarian cancer. Interviewer: When there was a ...

  12. Salivary Gland Cancer: Risk Factors

    ... Factors Request Permissions Print to PDF Salivary Gland Cancer: Risk Factors Approved by the Cancer.Net Editorial Board , 08/ ... anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do ...

  13. Microalbuminuria: a Cardiovascular Risk Factor

    ERCAN, Ertuğrul


    Albumin is a protein which is charged negatively. By correcting for the daily excretion of creatinine, the albumin creatinin ratio implicates the daily excretion of albumin in spot urine. Albuminuria is a cardiovascular risk factor in patients with diabetes, hypertension, and the general population. Urinary albumin excretion is independently associated with an increased risk of cardiovascular events, even after adjustment for risk factors. Risk has been shown to increase continuously with inc...

  14. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

    Hemodialysis (Hd) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescences immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients. (author)

  15. Physician-Related Factors Affecting Cardiac Rehabilitation Referral

    Bahieh Moradi


    Full Text Available Background: Despite the positive impact of cardiac rehabilitation (CR on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. Methods: A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigator-generated survey, examining the physician’s attitudinal and knowledge factors affecting CR referral. Results: 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs (79.5% such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians’ fee were other factors reported by the physicians. Conclusion: Cardiologists’ inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies.

  16. Cardiac risks associated with antibiotics: azithromycin and levofloxacin

    Lu, Zhiqiang Kevin; Yuan, Jing; Li, Minghui; Sutton, S Scott; Rao, Gowtham A; Jacob, Sony; Bennett, Charles L


    Introduction Azithromycin and levofloxacin have been shown to be efficacious in treating infections. The adverse drug events associated with azithromycin and levofloxacin were considered rare. However, the US FDA released warnings regarding the possible risk of QT prolongation with azithromycin and levofloxacin. Areas covered Case reports/case series, observational studies and clinical trials assessing cardiovascular risks associated with azithromycin and levofloxacin were critically reviewed, including 15 case reports/series, 5 observational studies and 5 clinical trials that investigated the cardiac risks associated azithromycin and levofloxacin. Expert opinion Results are discordant. Two retrospective studies utilizing large databases demonstrated an increased risk of cardiovascular death with azithromycin, when azithromycin was compared with amoxicillin. Two other retrospective studies found no difference in cardiovascular death associated with azithromycin and other antibiotics. For levofloxacin, the increased risk of cardiovascular death was only found in one retrospective study. Therefore, the risks and benefits of antibacterial therapies should be considered when making prescription decisions. This study should not preclude clinicians from avoiding azithromycin and levofloxacin. If a patient has an indication to receive an antibiotic and if azithromycin or levofloxacin is needed, it may be used, but the potential risks must be understood. PMID:25494485

  17. Does electrophysiological testing have any role in risk stratification for sudden cardiac death?

    Fei Lü; Wei Hua


    @@ Introduction Implantation of implantable cardioverter defibrillators (ICD) has widely been accepted for secondary prevention of sudden cardiac death (SCD) in cardiac arrest survivors.1 Currently there are increasing interests in primary prevention of SCD in selected high risk patients who have not experienced cardiac arrest.1

  18. Risk Factors for Teenage Fatherhood.

    Thornberry, Terence P.; Smith, Carolyn A.; Howard, Gregory J.


    Uses data from the Rochester Youth Development Study of urban youth (N=615) to identify early risk factors for the likelihood of becoming a teen father. Results show that teen fatherhood is related to a variety of risk factors, such as social class, educational performance, precocious sexual activity, and drug use. (RJM)

  19. Genetic Risk Factors

    Full Text Available ... option for high-risk women is to take tamoxifen, a drug long used to treat cancer. Dr. ... Zora Brown's case, for example, if we had tamoxifen out -- would that have helped? She sure would ...

  20. Genetic Risk Factors

    Full Text Available ... women who believe that having prophylactic mastectomy may prevent them from having breast cancer. I have a niece who's had prophylactic mastectomy. Announcer: Another preventative option for high-risk women is to take ...

  1. Environmental risk factors and pressures

    In this chapter the physical risk factors (as radiation [air contamination, contamination of the environment components and food contamination], radon and its radioactive decay products, radioactive wastes, noise), chemical risk factors [chemical substances, xenobiotics in the food chain the ozone depletion], wastes (waste generation, waste management, municipal waste management, import, export and transit of waste) and natural an technological hazards (water quality deterioration as a result of various accidents and fire risk) in the Slovak Republic in 1997 are reviewed

  2. Genetic Risk Factors

    Full Text Available ... having prophylactic mastectomy may prevent them from having breast cancer. I have a niece who's had prophylactic mastectomy. Announcer: Another preventative option for high-risk women is to take tamoxifen, a drug long used to treat cancer. Dr. Dewitty: In ...

  3. Genetic Risk Factors

    Full Text Available ... them and their health so much. I do worry that they are at risk and I wish they weren't. Announcer: For women who have the BRCA I gene, the most radical option is a prophylactic mastectomy, where healthy breasts are removed. This is effective in preventing ...

  4. Environmental risk factors for autism

    Rodney R. Dietert


    Full Text Available Autism is a devastating childhood condition that has emerged as an increasing social concern just as it has increased in prevalence in recent decades. Autism and the broader category of autism spectrum disorders are among the increasingly seen examples in which there is a fetal basis for later disease or disorder. Environmental, genetic, and epigenetic factors all play a role in determining the risk of autism and some of these effects appear to be transgenerational. Identification of the most critical windows of developmental vulnerability is paramount to understanding when and under what circumstances a child is at elevated risk for autism. No single environmental factor explains the increased prevalence of autism. While a handful of environmental risk factors have been suggested based on data from human studies and animal research, it is clear that many more, and perhaps the most significant risk factors, remain to be identified. The most promising risk factors identified to date fall within the categories of drugs, environmental chemicals, infectious agents, dietary factors, and other physical/psychological stressors. However, the rate at which environmental risk factors for autism have been identified via research and safety testing has not kept pace with the emerging health threat posed by this condition. For the way forward, it seems clear that additional focused research is needed. But more importantly, successful risk reduction strategies for autism will require more extensive and relevant developmental safety testing of drugs and chemicals.

  5. Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos Risk factors for postoperative bleeding after adult cardiac surgery

    Leonardo Augusto Miana


    measures for high-risk populations. METHODS: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and six postoperative variables were analyzed using univariate methods and multiple linear regression. RESULTS: Operative procedures included coronary artery bypass grafting in 227 (55.2% patients, valvar operations in 198 (48.2%, aortic surgery in 25 (6.1% and combined procedures in 60 (14.6%. Cardiopulmonary bypass was used in 335 (81.5% patients and anti-fibrinolysis agents in 148 (36%. The thirty-day mortality was 5.6% (23 patients. Mean 24-hour postoperative blood loss was 610 ± 500 ml (range 10-4900. Re-exploration for bleeding was required in 15 (3.7% patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049, postoperative metabolic acidosis (p=0.001, preoperative thrombocytopenia (p=0.034 and prolonged cardiopulmonary bypass (p=0.021. CCONCLUSIONS: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenias. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining cause.

  6. Is standardized cardiac assessment of asymptomatic high-risk renal transplant candidates beneficial?

    Aalten, J.; Peeters, S.A.; Vlugt, M.J. van der; Hoitsma, A.J.


    BACKGROUND: Perioperative cardiovascular events in renal transplantation are common and non-invasive cardiac stress tests are recommended in high-risk renal transplant candidates. In 2004, we introduced a standardized preoperative cardiac risk assessment programme with the aim of reducing perioperat

  7. Sudden Cardiac Arrest

    ... Heart Risk Factors & Prevention Heart Diseases & Disorders Atrial Fibrillation (AFib) Sudden Cardiac Arrest (SCA) SCA: Who's At Risk? Prevention of SCA What Causes SCA? SCA Awareness Atrial Flutter Heart Block Heart Failure Sick Sinus Syndrome Substances & Heart Rhythm Disorders Symptoms & ...

  8. Hidden Risk Factors for Women

    ... high cholesterol. “Those are the most common risk factors,” according to Steven J. Kittner, M.D., director of the Maryland Stroke Center at the University of Maryland School of Medicine in Baltimore. “But ...

  9. Cardiovascular risk factors in men

    Gyllenborg, J; Rasmussen, S L; Borch-Johnsen, Knut;


    Males have higher risk of cardiovascular disease (CVD) than premenopausal females. Gonadal steroids are probably involved in the gender difference in CVD, but previous results have been conflicting. We investigated the associations between CVD risk factors and sex hormones in a cross...

  10. Peptide growth factors can provoke "fetal" contractile protein gene expression in rat cardiac myocytes.

    Parker, T G; Packer, S E; Schneider, M. D.


    Cardiac-specific gene expression is intricately regulated in response to developmental, hormonal, and hemodynamic stimuli. To test whether cardiac muscle might be a target for regulation by peptide growth factors, the effect of three growth factors on the actin and myosin gene families was investigated by Northern blot analysis in cultured neonatal rat cardiac myocytes. Transforming growth factor-beta 1 (TGF beta 1, 1 ng/ml) and basic fibroblast growth factor (FGF, 25 ng/ml) elicited changes ...

  11. Depression as a risk factor for adverse outcomes in coronary heart disease

    Freedland, Kenneth E.; Carney, Robert M.


    Background Depression is firmly established as an independent predictor of mortality and cardiac morbidity in patients with coronary heart disease (CHD). However, it has been difficult to determine whether it is a causal risk factor, and whether treatment of depression can improve cardiac outcomes. In addition, research on biobehavioral mechanisms has not yet produced a definitive causal model of the relationship between depression and cardiac outcomes. Discussion Key challenges in this line ...



    Aim: Diminished cardiac output can lead to the development of white matter lesions. White matter lesions are related to cognitive impairment, stroke risk and vascular death, yet the precise aetiology is uncertain. Methods: In this study we recruited 130 patients attending our medicine and neurology outpatient department, and divided them into those with a history of heart failure (n:24), atrial fibrillation (n:26), and those with atherosclerotic risk factors (n:80). The patients without low o...

  13. Risk factors for suicidal behavior

    Antonova A.A.


    Full Text Available


    The article presents data on risk factors that contribute to the development of suicidal behavior. The development of suicidal behavior is infuenced by a number of factors. These include — gender, age, residence, occupation, marital status, health status, etc. A number of studies indicated the impact of economic and social factors on the level of suicidal activity of the population. Observed relationship between mental disorders, substance abuse (particularly alcohol and suicide. In this case, the presence of numerous investigations in the feld of Suicidology, a number of problems still remains unsolved. Further study of issues relating to risk factors that infuence the development of suicidal behavior. Of particular note is the importance of “regional” risk factors that most infuence on the formation of suicidal behavior in a particular region.

  14. Through thick and thin: A circulating growth factor inhibits age-related cardiac hypertrophy

    McPherron, Alexandra C


    In an intriguing new study, Loffredo et al., report that joining the circulation of old mice with that of young mice reduces age-related cardiac hypertrophy. They also found that the growth factor GDF11 is a circulating negative regulator of cardiac hypertrophy which suggests that raising GDF11 levels may be useful to treat cardiac hypertrophy associated with aging.

  15. Human Leptospirosis and risk factors.

    Yanelis Emilia Tabío Henry; Yailín Palmero Dones; Elizabeth Cruz Pérez


    The human leptospirosis is a zoonosis of world distribution, were risk factors exist that have favored the wild and domestic animal propagation and so man. A descpitive investigation was made with the objective of determining the behavior of risk factors in outpatients by human leptospirosis in “Camilo Cienfuegos“ University General Hospital from Sncti Spíritus In the comprised time period betwen december 1 st and 3 st , 2008.The sample of this study was conformed by 54 risk persons that kee...

  16. Long-Term Exercise and Risk of Metabolic and Cardiac Diseases: The Erlangen Fitness and Prevention Study

    Wolfgang Kemmler


    Full Text Available In female subjects, ageing and the menopausal transition contribute to a rapid increase of metabolic and cardiac risk factors. Exercise may be an option to positively impact various risk factors prone to severe metabolic and cardiac diseases and events. This study was conducted to determine the long-term effect of a multipurpose exercise program on metabolic and cardiac risk scores in postmenopausal women. 137 osteopenic Caucasian females (55.4 ± 3.2 yrs, 1–8 years postmenopausal, were included in the study. Eighty-six subjects joined the exercise group (EG and performed an intense multipurpose exercise program which was carefully supervised during the 12-year period, while 51 females maintained their habitual physical activity (CG. Main outcome measures were 10-year coronary heart disease risk (10 y CHD risk, metabolic syndrome Z-score (MetS Index, and 10-year myocardial infarction risk (10 y hard CHD risk. Significant between-group differences all in favor of the EG were determined for 10 y-CHD risk (EG: 2.65±2.09% versus CG: 5.40±3.30%; P=0.001, MetS-Index (EG: −0.42±1.03% versus CG: 1.61±1.88; P=0.001, and 10 y-hard-CHD risk (EG: 2.06±1.17% versus CG: 3.26±1.31%; P=0.001. Although the nonrandomized design may prevent definite evidence, the intense multi-purpose exercise program determined the long-term efficacy and feasibility of an exercise program to significantly impact metabolic and cardiac risk scores in postmenopausal women. This trial is registered with NCT01177761.

  17. The FOXO3a Transcription Factor Regulates Cardiac Myocyte Size Downstream of AKT Signaling*

    Skurk, Carsten; Izumiya, Yasuhiro; Maatz, Henrike; Razeghi, Peter; Shiojima, Ichiro; Sandri, Marco; Sato, Kaori; Zeng, Ling; Schiekofer, Stephan; Pimentel, David; Lecker, Stewart; Taegtmeyer, Heinrich; Goldberg, Alfred L.; Walsh, Kenneth


    Although signaling mechanisms inducing cardiac hypertrophy have been extensively studied, little is known about the mechanisms that reverse cardiac hypertrophy. Here, we describe the existence of a similar Akt/forkhead signaling axis in cardiac myocytes in vitro and in vivo, which is regulated by insulin, insulin-like growth factor (IGF), stretch, pressure overload, and angiotensin II stimulation. FOXO3a gene transfer prevented both IGF and stretch-induced hypertrophy in rat neonatal cardiac ...

  18. Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias

    Levine, Benjamin D.; Bungo, Michael W.; Platts, Steven H.; Hamilton, Douglas R.; Johnston, Smith L.


    Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias (Integrated Cardiovascular) will quantify the extent of long-duration space flightassociated cardiac atrophy (deterioration) on the International Space Station crewmembers.

  19. Risk factors of cerebrovascular diseases and their intervention and management

    En XU


    Full Text Available Cerebrovascular diseases are important causes of clinical death and disability because of high prevalence and morbidity and easy to recurrence. A number of risk factors have involved in the progress of cerebrovascular diseases, which include uncontrolled and controlled risk factors. The former refers to old age, gender, low birth weight, race/ethnicity, genetic factors, etc. The latter includes hypertension, diabetes mellitus, atrial fibrillation and other cardiac diseases, dyslipidemia, asymptomatic carotid stenosis, obesity, smoking, unhealthy lifestyle, alcoholism, metabolic syndrome, hyperhomocysteinemia, etc. Meanwhile, hypertension is the most important one in the above-mentioned risk factors. It would effectively reduce or postpone the onset of cerebrovascular diseases through proper intervention and management on those risk factors. DOI: 10.3969/j.issn.1672-6731.2015.01.006

  20. What Are Coronary Heart Disease Risk Factors?

    ... from the NHLBI on Twitter. What Are Coronary Heart Disease Risk Factors? Coronary heart disease risk factors are ... high blood pressure, overweight and obesity, and others. Heart Disease Risk Factors 09/30/2011 This video—presented ...

  1. Specification of the Cardiac Conduction System by Transcription Factors

    Hatcher, Cathy J.; Basson, Craig T.


    Diseases of the cardiovascular system that cause sudden cardiac deaths are often caused by lethal arrhythmias that originate from defects in the cardiac conduction system. Development of the cardiac conduction system is a complex biological process that can be wrought with problems. Although several genes involved in mature conduction system function have been identified, their association with development of specific subcomponents of the cardiac conduction system remains challenging. Several...

  2. Genetic and environmental factors in cardiac sodium channel disease

    Y. Mizusawa


    Cardiac sodium channelopathies, such as long QT syndrome type3 (LQT3), Brugada syndrome (BrS) and cardiac conduction disease (CCD), are heritable diseases associated with mutations in the SCN5A gene and sudden cardiac death. They were classically thought to be a monogenic disease. However, while LQT

  3. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease

    Nicolas W Shammas


    Full Text Available Nicolas W ShammasMidwest Cardiovascular Research Foundation, Cardiovascular Medicine, PC, Davenport, IA, USAAbstract: Peripheral arterial disease (PAD is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.Keywords: peripheral arterial disease, epidemiology, risk factors, classification

  4. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

    Koh, Angela S. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); National Heart Centre Singapore, Singapore (Singapore); Murthy, Venkatesh L.; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Wu, Justina [Brigham and Women' s Hospital, Division of Cardiology, Department of Medicine, and the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Department of Radiology and the Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, MA (United States)


    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical {sup 82}Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

  5. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical 82Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

  6. Risk factors for eating disorders

    Monterrosa-Castro Álvaro


    Full Text Available Introduction: eating disorders (ED are characterized by the excessive worry aboutphysical appearance. They have high incidence in young population with more frequencyin women than in men.Objective: to identify the risk factors for ED.Methods: thematic review of publications in which are described and evaluated thedifferent risk factors to develop ED. It was done an electronic search since 1984 to2011, in english and spanish, in which were included all the methods of publications.There were reviewed the summaries to find the complete articles that treated about riskfactors associate with the development of the ED.Results: there were found 48203 about ED. 96 tried specifically about risk factors. 35(36.4% complete articles were obtained and the review was done with them.Conclusion: principal risk factors are: To be an adolescent, woman, to have distortedperception of the corporal image and the use of diet to lose weight. Rev.cienc.biomed.2012;3(2:300-305

  7. Detecting Risk Factor of Diseases

    Zvárová, Jana


    Roč. 15, 1/2 (1995), s. 203-212. ISSN 0208-5216. [Seminar on Statistics and Clinical Practice. Warsaw, 20.06.1994-23.06.1994] Keywords : risk factors * genetics * association * epidemilogy * measures of association * screening * genetics

  8. Seasonality of cardiovascular risk factors

    Marti-Soler, Helena; Gubelmann, Cédric; Aeschbacher, Stefanie;


    OBJECTIVE: To assess the seasonality of cardiovascular risk factors (CVRF) in a large set of population-based studies. METHODS: Cross-sectional data from 24 population-based studies from 15 countries, with a total sample size of 237 979 subjects. CVRFs included Body Mass Index (BMI) and waist...

  9. [Psoriasis and cardiovascular risk factors].

    Tal, Roy; Pavlovsky, Lev; David, Michael


    Psoriasis is a common inflammatory skin disease which may dramatically affect patients' lives. This chronic disease is characterized by a protracted course of alternating remissions and relapses. In recent years, the attention of researchers has focused on the association between psoriasis and cardiovascular disease risk factors. This review summarizes the literature on this topic with an emphasis on research conducted in Israel. PMID:23316664


    Srinivasa Rao


    Full Text Available INTRODUCTION: Cerebral palsy (CP is a group of permanent movement disorders that appear in early childhood. Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. AIM: To study the different antenatal maternal risk factors associated with cerebral palsy in the study group. MATERIA LS AND METHODS: Retrospective study was done to assess possible associated antenatal risk factors for cerebral palsy. Mothers of 100 cerebral palsy children were selected who are treated in Rani Chandramani Devi Hospital, a Government hospital in Visakhapa tn am, Andhra Pradesh State, India , from 2012 to 2014 and 100 controls, mothers of normal children were studied. Detailed antenatal history was obtained from the mothers of the children in both affected and control group. RESULTS: From the data, we conclude that the association of maternal anaemia with cerebral palsy is 7.3 times higher; association of maternal hypertension with cerebral palsy is 6.6 time higher, association with Pre - eclampsia is 6 times higher; association with Eclampsia is 8.6 times higher ; with antepartum haemorrhage, the association is 8.6 times higher and association of multiple pregnancy with cerebral palsy is 4.8 times higher than with controls. CONCLUSION: From this study of the role of antenatal risk factors, in the occurrence of cer ebral palsy in children it is concluded that the most common risk factor associated with cerebral palsy is the maternal anaemia and the other important risk factors associated being hypertension, pre eclampsia, eclampsia, antepartum haemorrhage and multipl e births.

  11. Comparative Cardiac Risks of Methylphenidate and Amphetamines in Treatment of ADHD

    J Gordon Millichap


    Full Text Available The risk for adverse cardiac events in subjects between 3 and 20 years of age treated with methylphenidate or amphetamine salts for ADHD was determined in a retrospective study at University of Florida, Gainesville, FL.

  12. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future

  13. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A;


    bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P < 0.05 performed only slightly better, c-statistic = 0.81, but was limited in use by its complexity. CONCLUSIONS: For patients with heart failure, this simple......BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals with...... heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...

  14. Other Possible Heart Disease Risk Factors

    ... your risk Heart Health and Stroke Other possible heart disease risk factors Related information Depression fact sheet Stress ... Return to top More information on Other possible heart disease risk factors Read more from Heart ...

  15. Women's Heart Disease: Heart Disease Risk Factors

    ... this page please turn JavaScript on. Feature: Women's Heart Disease Heart Disease Risk Factors Past Issues / Winter 2014 Table of ... or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk factors. ...

  16. Heart Disease Risk Factors You Can Control

    ... disease: Know your risk Heart Health and Stroke Heart disease risk factors you can control Did you know? ... overall health. Return to top More information on Heart disease risk factors you can control Read more from ...

  17. Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

    Satoshi Kurokawa


    Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.


    Santosh; Rangaswamy


    INTRODUCTION : Cardiovascular disease is the commonest cause of death globally. Acute myocardial infarction generally occurs when coronary blood flow decreases abruptly after thrombotic occlusion of a coronary artery causing focal or massive necrosis of cardiac muscle. The risk factor concept implies that a person with one risk factor is more likely to develop clinical atherosclerotic event and is more likely to do so earlier than a person with no risk factors. The presen...


    Xin-Feng Liu; Guy van Melle; Julien Bogousslavsky


    Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry.Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were prospectively coded and entered into a computerized data bank.Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hypercholesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.

  20. Cardiac tissue enriched factors serum response factor and GATA-4 are mutual coregulators

    Belaguli, N. S.; Sepulveda, J. L.; Nigam, V.; Charron, F.; Nemer, M.; Schwartz, R. J.


    Combinatorial interaction among cardiac tissue-restricted enriched transcription factors may facilitate the expression of cardiac tissue-restricted genes. Here we show that the MADS box factor serum response factor (SRF) cooperates with the zinc finger protein GATA-4 to synergistically activate numerous myogenic and nonmyogenic serum response element (SRE)-dependent promoters in CV1 fibroblasts. In the absence of GATA binding sites, synergistic activation depends on binding of SRF to the proximal CArG box sequence in the cardiac and skeletal alpha-actin promoter. GATA-4's C-terminal activation domain is obligatory for synergistic coactivation with SRF, and its N-terminal domain and first zinc finger are inhibitory. SRF and GATA-4 physically associate both in vivo and in vitro through their MADS box and the second zinc finger domains as determined by protein A pullout assays and by in vivo one-hybrid transfection assays using Gal4 fusion proteins. Other cardiovascular tissue-restricted GATA factors, such as GATA-5 and GATA-6, were equivalent to GATA-4 in coactivating SRE-dependent targets. Thus, interaction between the MADS box and C4 zinc finger proteins, a novel regulatory paradigm, mediates activation of SRF-dependent gene expression.

  1. Environmental risk factors for autism

    Dietert, Rodney R.; Janice M. Dietert; DeWitt, Jamie C.


    Autism is a devastating childhood condition that has emerged as an increasing social concern just as it has increased in prevalence in recent decades. Autism and the broader category of autism spectrum disorders are among the increasingly seen examples in which there is a fetal basis for later disease or disorder. Environmental, genetic, and epigenetic factors all play a role in determining the risk of autism and some of these effects appear to be transgenerational. Identification of the most...


    Srinivasa Rao; Vidyullatha; Subbalakshmi


    INTRODUCTION: Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. AIM: To study the different antenatal maternal risk factors associated with cere...

  3. Benefits of quantitative gated SPECT in evaluation of perioperative cardiac risk in noncardiac surgery

    Gated single-photon emission computed tomography (G-SPECT) was used to evaluate cardiac risk associated with noncardiac surgery and determine the benefits and indications of this technique for this type of surgery. Patients scheduled to undergo noncardiac surgery under the supervision of anesthesiologists and subjected to preoperative cardiac evaluation using G-SPECT during the 26-month period between June 2000 and August 2002 were followed for the presence/absence of cardiac events (id est (i.e.), cardiac death, myocardial infarction, unstable angina, congestive heart failure, or fatal arrhythmia) during surgery and the postoperative period until discharged. Relationships between the occurrence of cardiac events and preoperative G-SPECT findings were evaluated. A total of 39 patients underwent G-SPECT; 6 of the 39 exhibited abnormal ejection fraction (left ventricular ejection fraction, left ventricular ejection fraction (LVEF)≤50%) and end-systolic volume (end-systolic volume (ESV)≥50 ml). Surgery was suspended for three of these six patients and cardiac events developed in the remaining three patients. Both abnormal perfusion images (PI) and abnormal wall thickening (WT) were observed in all six patients. All six patients exhibited abnormal LVEF and/or ESV. Three patients had either abnormal PI or WT, and a cardiac event occurred in one of them. Of the five patients who experienced cardiac events during or after surgery, two exhibited a short run of ventricular tachycardia requiring a continuous administering of antiarrhythmic drugs, whereas the remaining three patients exhibited cardiac failure requiring inotropic support following surgery. The results of this study indicate that the occurrence of perioperative cardiac events can be predicted by considering the severity of expected surgical stress and preoperative G-SPECT findings for LVEF, PI, and WT. We conclude that G-SPECT is quite useful for cardiac risk assessment in patients undergoing noncardiac

  4. Cardiac Rehabilitation Patient and Organizational Factors: What Keeps Patients in Programs?

    Turk‐Adawi, Karam I.; Oldridge, Neil B; Tarima, Sergey S.; Stason, William B.; Shepard, Donald S.


    Background Despite documented benefits of cardiac rehabilitation, adherence to programs is suboptimal with an average dropout rate of between 24% and 50%. The goal of this study was to identify organizational and patient factors associated with cardiac rehabilitation adherence. Methods and Results Facilities of the Wisconsin Cardiac Rehabilitation Outcomes Registry Project (N=38) were surveyed and records of 4412 enrolled patients were analyzed. Generalized estimating equations were used to a...

  5. Critical factors in case management: practical lessons from a cardiac case management program.

    Stafford, Randall S; Berra, Kathy


    Case management (CM) is an important strategy for chronic disease care. By utilizing non-physician providers for conditions requiring ongoing care and follow-up, CM can facilitate guideline-concordant care, patient empowerment, and improvement in quality of life. We identify a series of critical factors required for successful CM implementation. Heart to Heart is a clinical trial evaluating CM for coronary heart disease (CHD) risk reduction in a multiethnic, low-income population. Patients at elevated cardiac risk were randomized to CM plus primary care (212 patients) or to primary care alone (207). Over a mean follow-up of 17 months, patients received face-to-face nurse and dietitian visits. Mean contact time was 14 hours provided at an estimated cost of $1250 per patient for the 341 (81%) patients completing follow-up. Visits emphasized behavior change, risk-factor monitoring, self-management skills, and guideline-based pharmacotherapy. A statistically significant reduction in mean Framingham risk probability occurred in CM plus primary care relative to primary care alone (1.6% decrease in 10-year CHD risk, p = 0.007). Favorable changes were noted across individual risk factors. Our findings suggest that successful CM implementation relies on choosing appropriate case managers and investing in training, integrating CM into existing care systems, delineating the scope and appropriate levels of clinical decision making, using information systems, and monitoring outcomes and costs. While our population, setting, and intervention model are unique, these insights are broadly relevant. If implemented with attention to critical factors, CM has great potential to improve the process and outcomes of chronic disease care. PMID:17718658

  6. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren; Frederiksen, Marianne; Abadini, Sadollah; Appel, Jon; Rasmussen, Hanne; Gluud, Christian; Iversen, Lars; Sigurd, Bjarne; Madsen, Mette; Fischer-Hansen, Jørgen; Group, DANREHAB


    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic ...... Depression Scale did not differ significantly. CONCLUSION: At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome. Comprehensive cardiac rehabilitation significantly reduced length of hospital stay and improved cardiac risk factors.......BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic......, risk profile, and quality of life. The trial included 770 participants (20-94 years) with congestive heart failure (12%), ischemic heart disease (58%), or high risk of ischemic heart disease (30%). Comprehensive cardiac rehabilitation is composed of 6 weeks of intensive intervention and systematic...

  7. Perinatal risk factors including malformation

    The study gives a survey of the factors most frequently mentioned in the literature as factors likely to adversely affect a pregnancy. One essential aspect is the discussion of those factors that can be counted among the causes of malformations, as among others, prenatal radiation exposure. The study prepared within the framework of the research project 'Radiobiological environmental monitoring in Bavaria' is intended to serve as a basis for a retrospective and prospective evaluation of infant mortality, perinatal conditions and occurrence of malformations in Bavaria, with the principal idea of drawing up an environment - related health survey. The study therefore, in addition to ionizing radiation also takes into account other detectable risks within the ecologic context, as e.g. industrial installations, refuse incineration plants or waste dumps, or urbanity. (orig./MG)

  8. Prospective evaluation of stress myocardial perfusion imaging for pre-operative cardiac risk assessment

    Full text: A prospective evaluation of patients who underwent stress myocardial perfusion imaging (MPI) to assess preoperative cardiac risk was undertaken. At the time of the scan patients were classified into 4 Clinical Risk groups (CR) based on known clinical data. On completion of the scan, the patient was then categorised into 4 Scan based Risk groups (SR), incorporating size of perfusion deficit, single versus multi-vessel disease and ejection fraction. Surgery at Austin and Repatriation Medical Centre within 6 months of scan and complications were identified using the hospital medical database. Major early cardiac events coded were death (cardiac related), myocardial infarction, unstable angina, acute pulmonary oedema, cardiac arrest, and urgent revascularisation. 208 patients have reached 6 months post-MPI scan. Of these 119 (57%) were identified as having surgery. Of the Scan Risk groups, 63% of normal, 57% of increased, and 47% of high and very high groups have had surgery. An abnormal scan is associated with a three-fold risk of cardiac complication (3.5% vs 11.3%). This is lower than most previous reports and may be due to higher representation of low risk surgical procedures (14% in this series), improved peri-operative care and/or the test result influence on management (suggested by decreasing surgical rate as SR estimate rose). Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  9. Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery

    Juul, A B; Wetterslev, J; Kofoed-Enevoldsen, A


    a major risk factor for both short-term ( 30 days) patients especially after major cardiac surgery. We examined the long-term postoperative mortality of diabetic patients undergoing major non-cardiac surgery to identify possible perioperative risk factors....

  10. Risk Factors in Derivatives Markets

    Raimonda Martinkutė-Kaulienė


    Full Text Available The objective of the article is to analyse and present the classification of risks actual to derivative securities. The analysis is based on classical and modern literature findings and analysis of newest statistical data. The analysis led to the conclusion, that the main risks typical for derivatives contracts and their traders are market risk, liquidity risk, credit and counterparty risk, legal risk and transactions risk. Pricing risk and systemic risk is also quite important. The analysis showed that market risk is the most important kind of risk that in many situations influences the level of remaining risks.

  11. Risk factors of teenage pregnancy

    Maria Siettou; Maria Saridi


    Teenage pregnancy is a worldwide medical and social issue, associated with many physical, psychological and social consequences and can result in birth, miscarriage or abortion. Aim: The aim of the present study is to find those risk factors that contribute to teenage pregnancy. Results: In U.S.A., according to data from Unicef, the birth rate among teenagers touches the 52.1% and it is four times higher, than the corresponding rate recorded in the countries of Western Europe. The United King...

  12. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    McCarthy, M.C.; Larcos, G.; Chapman, J. [Westmead Hospital, Westmead, Sydney, NSW (Australia). Departments of Nuclear Medicine and Ultrasound


    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  13. Non-sedating antihistamine drugs and cardiac arrhythmias : biased risk estimates from spontaneous reporting systems?

    De Bruin, M L; van Puijenbroek, E P; Egberts, A C G; Hoes, A W; Leufkens, H G M


    AIMS: This study used spontaneous reports of adverse events to estimate the risk for developing cardiac arrhythmias due to the systemic use of non-sedating antihistamine drugs and compared the risk estimate before and after the regulatory action to recall the over-the-counter status of some of these

  14. Skin Cancer: Biology, Risk Factors & Treatment

    ... turn Javascript on. Feature: Skin Cancer Skin Cancer: Biology, Risk Factors & Treatment Past Issues / Summer 2013 Table ... Articles Skin Cancer Can Strike Anyone / Skin Cancer: Biology, Risk Factors & Treatment / Timely Healthcare Checkup Catches Melanoma ...

  15. Risk factors identified for certain lymphoma subtypes

    In a large international collaborative analysis of risk factors for non-Hodgkin lymphoma (NHL), scientists were able to quantify risk associated with medical history, lifestyle factors, family history of blood or lymph-borne cancers, and occupation for 11

  16. Risk factors for venous thromboembolism during pregnancy

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi; Bretler, Ditte-Marie; Schmiegelow, Michelle Dalgas; Andersson, Charlotte; Azimi, Aziza; Gislason, Gunnar; Torp-Pedersen, Christian; Olesen, Jonas Bjerring


    Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.......Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated....

  17. Risk factors for colorectal cancer

    Mihajlović-Božić Vesna


    Full Text Available Colorectal cancer is one of the most common cancers in human population. It causes significant morbidity and mortality in our country. The incidence of colorectal cancer increases in the fifth decade of life. The aim of this study was to evaluate the association between colorectal cancer and potential risk factors. A case-control study of colorectal cancer was carried out between 1998 and 1999 in Clinical Center of Serbia, Center for Digestive Surgery. A total of 100 cases of newly diagnosed patients with colorectal cancer confirmed by histopathology and an equal number of controls, individually matched by gender and age (+/-5 years, were chosen from patients from the same hospital with no history of cancer at all. McNemar test and conditional logistic regression were used in the analysis. According to logistic regression analysis the following risk factors were independently related with the occurrence of colorectal cancer: cigarette smoking, alcohol consumption, and diet rich in red meat and fat promote the carcinogenic process; food rich in vegetables, fruits, grains, vitamin C, physical activity, and oral contraceptive use inhibit the same process. A family history of cancer and long standing inflammatory bowel diseases also have significant role. There is convincing evidence that nutrition affects colorectal carcinogenesis in a complex fashion.

  18. Cardiovascular risk factors among Chamorros

    Wu Phillis L


    Full Text Available Abstract Background Little is known regarding the cardiovascular disease risk factors among Chamorros residing in the United States. Methods The Chamorro Directory International and the CDC's Behavioral Risk Factor Surveillance System Questionnaire (BRFSS were used to assess the health related practices and needs of a random sample of 228 Chamorros. Results Inactivity, hypertension, elevated cholesterol and diabetes mellitus were more prevalent in this Chamorro sample compared to the US average. Participants who were 50-and-older or unemployed were more likely to report hypertension, diabetes and inactivity, but they were also more likely to consume more fruits and vegetables than their younger and employed counterparts. Women were more likely to report hypertension and diabetes, whereas men were more likely to have elevated BMI and to have never had their blood cholesterol checked. Conclusion The study provides data that will help healthcare providers, public health workers and community leaders identify where to focus their health improvement efforts for Chamorros and create culturally competent programs to promote health in this community.

  19. Configurations of Common Childhood Psychosocial Risk Factors

    Copeland, William; Shanahan, Lilly; Costello, E. Jane; Angold, Adrian


    Background: Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors. Methods: Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class…

  20. Transcription factors ETS2 and MESP1 transdifferentiate human dermal fibroblasts into cardiac progenitors.

    Islas, Jose Francisco; Liu, Yu; Weng, Kuo-Chan; Robertson, Matthew J; Zhang, Shuxing; Prejusa, Allan; Harger, John; Tikhomirova, Dariya; Chopra, Mani; Iyer, Dinakar; Mercola, Mark; Oshima, Robert G; Willerson, James T; Potaman, Vladimir N; Schwartz, Robert J


    Unique insights for the reprograming of cell lineages have come from embryonic development in the ascidian Ciona, which is dependent upon the transcription factors Ci-ets1/2 and Ci-mesp to generate cardiac progenitors. We tested the idea that mammalian v-ets erythroblastosis virus E26 oncogene homolog 2 (ETS2) and mesoderm posterior (MESP) homolog may be used to convert human dermal fibroblasts into cardiac progenitors. Here we show that murine ETS2 has a critical role in directing cardiac progenitors during cardiopoiesis in embryonic stem cells. We then use lentivirus-mediated forced expression of human ETS2 to convert normal human dermal fibroblasts into replicative cells expressing the cardiac mesoderm marker KDR(+). However, although neither ETS2 nor the purported cardiac master regulator MESP1 can by themselves generate cardiac progenitors de novo from fibroblasts, forced coexpression of ETS2 and MESP1 or cell treatment with purified proteins reprograms fibroblasts into cardiac progenitors, as shown by the de novo appearance of core cardiac transcription factors, Ca(2+) transients, and sarcomeres. Our data indicate that ETS2 and MESP1 play important roles in a genetic network that governs cardiopoiesis. PMID:22826236

  1. Risk stratification for sudden cardiac death: current approaches and predictive value.

    Lopera, Gustavo; Curtis, Anne B


    Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers. PMID:20066150

  2. Fibroblast growth factor-2 regulates human cardiac myofibroblast-mediated extracellular matrix remodeling

    Svystonyuk, Daniyil A; Ngu, Janet MC; Mewhort, Holly EM; Lipon, Brodie D; Teng, Guoqi; Guzzardi, David G; Malik, Getanshu; Belke, Darrell D.; Fedak, Paul WM


    Background Tissue fibrosis and chamber remodeling is a hallmark of the failing heart and the final common pathway for heart failure of diverse etiologies. Sustained elevation of pro-fibrotic cytokine transforming growth factor-beta1 (TGFβ1) induces cardiac myofibroblast-mediated fibrosis and progressive structural tissue remodeling. Objectives We examined the effects of low molecular weight fibroblast growth factor (LMW-FGF-2) on human cardiac myofibroblast-mediated extracellular matrix (ECM)...

  3. Antipsychotics and Associated Risk of Out-of-Hospital Cardiac Arrest

    Weeke, Peter; Jensen, Aksel; Folke, Fredrik;


    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug...... use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of event. Overall treatment with any antipsychotic was associated with OHCA (odds ratio [OR]= 1.53, 95...

  4. Role of paracrine factors in stem and progenitor cell mediated cardiac repair and tissue fibrosis

    Burchfield Jana S


    Full Text Available Abstract A new era has begun in the treatment of ischemic disease and heart failure. With the discovery that stem cells from diverse organs and tissues, including bone marrow, adipose tissue, umbilical cord blood, and vessel wall, have the potential to improve cardiac function beyond that of conventional pharmacological therapy comes a new field of research aiming at understanding the precise mechanisms of stem cell-mediated cardiac repair. Not only will it be important to determine the most efficacious cell population for cardiac repair, but also whether overlapping, common mechanisms exist. Increasing evidence suggests that one mechanism of action by which cells provide tissue protection and repair may involve paracrine factors, including cytokines and growth factors, released from transplanted stem cells into the surrounding tissue. These paracrine factors have the potential to directly modify the healing process in the heart, including neovascularization, cardiac myocyte apoptosis, inflammation, fibrosis, contractility, bioenergetics, and endogenous repair.

  5. Risk Factors for Atrial Fibrillation

    Krijthe, Bouwe


    textabstractAtrial fibrillation is a common cardiac arrhythmia that is characterized by rapid disorganized atrial electrical activity resulting in absence of atrial contractions. It is diagnosed on the basis of typical findings on an electrocardiogram (ECG). The characteristic ECG findings are absence of P-waves, and an irregular heart rate. Symptoms of atrial fibrillation include palpitations, dyspnea, reduced exercise capacity, chest pain and dizziness, but it often goes without symptoms. A...

  6. Obesity, Exercise, Obstructive Sleep Apnea, and Modifiable Atherosclerotic Cardiovascular Disease Risk Factors in Atrial Fibrillation.

    Miller, Jared D; Aronis, Konstantinos N; Chrispin, Jonathan; Patil, Kaustubha D; Marine, Joseph E; Martin, Seth S; Blaha, Michael J; Blumenthal, Roger S; Calkins, Hugh


    Classically, the 3 pillars of atrial fibrillation (AF) management have included anticoagulation for prevention of thromboembolism, rhythm control, and rate control. In both prevention and management of AF, a growing body of evidence supports an increased role for comprehensive cardiac risk factor modification (RFM), herein defined as management of traditional modifiable cardiac risk factors, weight loss, and exercise. In this narrative review, we summarize the evidence demonstrating the importance of each facet of RFM in AF prevention and therapy. Additionally, we review emerging data on the importance of weight loss and cardiovascular exercise in prevention and management of AF. PMID:26718677

  7. Air Pollution and the Risk of Cardiac Defects: A Population-Based Case-Control Study.

    Hwang, Bing-Fang; Lee, Yungling Leo; Jaakkola, Jouni J K


    Previous epidemiologic studies have assessed the role of the exposure to ambient air pollution in the development of cardiac birth defects, but they have provided somewhat inconsistent results. To assess the associations between exposure to ambient air pollutants and the risk of cardiac defects, a population-based case-control study was conducted using 1087 cases of cardiac defects and a random sample of 10,870 controls from 1,533,748 Taiwanese newborns in 2001 to 2007.Logistic regression was performed to calculate odds ratios for 10 ppb increases in O3 and 10 μg/m increases in PM10. In addition, we compared the risk of cardiac defects in 4 categories-high exposure (>75th percentile); medium exposure (75th to 50th percentile); low exposure (patent ductus arteriosus (PDA) were associated with 10 ppb increases in O3 exposure during the first 3 gestational months among term and preterm babies. In comparison between high PM10 exposure and reference category, there were statistically significant elevations in the effect estimates of ASD for all and terms births. In addition, there was a negative or weak association between SO2, NO2, CO, and cardiac defects.The study proved that exposure to outdoor air O3 and PM10 during the first trimester of gestation may increase the risk of VSD, ASD, and PDA. PMID:26554783

  8. Risk factors of thrombosis in abdominal veins

    Amit Kumar Durra; Ashok Chacko; Biju George; Joseph Anjilivelil Joseph; Sukesh Chandran Nair; Vikram Mathews


    AIM: To estimate the prevalence of inherited and acquired thrombophilic risk factors in patients with abdominal venous thrombosis and to compare the risk factor profiles between Budd-Chiari syndromes (BCS) and splanchnic vein thrombosis (SVT).METHODS: In this retrospective study, 36 patients with abdominal venous thrombosis were studied.The patients were divided into Budd-Chiari group (hepatic vein, IVC thrombosis) and splanchnic venous thrombosis group (portal, splenic, superior mesenteric veins) based on the veins involved. Hereditary and acquired thrombophilic risk factors were evaluated in all patients.RESULTS: Twenty patients had SVT, 14 had BCS,and 2 had mixed venous thrombosis. Ten patients (28%) had hereditary and 10 patients (28%) acquired thrombophilic risk factors. The acquired risk factors were significantly more common in the SVT group (SVT vs BCS:45% vs 7%,x2=5.7,P=0.02) while hereditary risk factors did not show significant differences between the two groups (SVT vs BCS: 25%vs 36%, x2=0.46,P=0.7). Multiple risk factors were present in one (7%) patient with BCS and in 3 patients (15%) with SVT. No risk factors were identified in 57% of patients with BCS and in 45% of patients with SVT.CONCLUSION: Hereditary and acquired risk factors play an important role in the etiopathogenesis of abdominal venous thrombosis. Acquired risk factors are significantly more common in SVT patients while hereditary factors are similar in both groups.

  9. Information Asymmetry as a Risk Factor

    Viktor Ya. Tsvetkov


    This paper explores information asymmetry as the cause of risks in decision making. The author describes the types of information asymmetry as a risk factor; describes the types of risk arising under different information asymmetries; describes the methods for minimizing such risks; brings to light the principal-agent issue; analyzes the principles of minimizing risks in the event of this issue arising; illustrates the application of special information models for minimizing risks in this iss...

  10. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析%Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute kidney injury following cardiac surgery

    丁文军; 刘华; 季强; 王玺胜; 蔡建志; 梅运清


    目的 评估连续性静脉-静脉血液透析(CVVHD)治疗心脏术后急性肾损伤(AKI)失败的危险因素.方法 2005年1月-2012年12月在同济医院心胸外科因心脏手术后AKI行CVVHD治疗的成年患者分为CVVHD治疗失败组和治疗成功组.回顾性分析患者术前、术中、术后相关临床资料.结果 93例患者被纳入该研究,其中63例治疗成功,30例治疗失败,CVVHD治疗失败率为32.2%,病死率19.4%.通过单因素分析和多因素Logistic回归分析,CVVHD治疗心脏术后AKI失败的独立危险因素有:术前LVEF(OR =0.61,95% CI0.42~0.85)和从少尿到透析的间隔时间(OR=2.76,95%CI 1.51 ~5.83).结论 术前左室受损是CVVHD治疗心脏术后AKI失败的危险因素.CVVHD实施越早,患者预后越好.%Objective To evaluate the independent risk factors for failure of continuous venovenous hemodialysis (CVVHD) in the treatment of acute kidney injury (AKI) following cardiac surgery.Methods Adult patients without any prior pre-operative history of chronic renal disease suffering AKI following cardiac surgery and undergoing CWHD at our center from January 2005 to December 2012 were recruited and divided into either a success group or a failure group.All pre-,intra-and post-operative data were collected and retrospectively analyzed.Results Ninety-three adult patients were enrolled.Among them,sixty-three patients survived with a failure rate of 32.2% and a mortality rate of 19.4%.Through univafiate analysis and multivariate Logistic regression,independent risk factors for failure of CVVHD in the treatment of post-operative AKI included pre-operative LVEF (OR =0.61,95% CI O.42-0.85) and duration of oliguria until dialysis (OR =2.76,95% CI 1.51-5.83).Conclusion Pre-operative impaired left ventricular function is an important risk factor for failure of CVVHD in the treatment of AKI after cardiac surgery.The sooner the implementation of CVVHD,the better prognosis.

  11. Risk Factors for High Blood Pressure

    ... the NHLBI on Twitter. Risk Factors for High Blood Pressure Anyone can develop high blood pressure; however, age, ... can increase your risk for developing high blood pressure. Age Blood pressure tends to rise with age. About 65 ...

  12. CDC Behavioral Risk Factor Surveillance System (BRFSS)

    U.S. Department of Health & Human Services — The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based system of health surveys that collects information on health risk behaviors, preventive...

  13. About Alzheimer's Disease: Risk Factors and Prevention

    ... Alzheimer's Project Act (NAPA) About ADEAR About Alzheimer's Disease: Risk Factors and Prevention We can’t control some risk factors for ... Preventing Alzheimer’s Disease: What Do We Know? Alzheimer's Disease: Unraveling the Mystery ... Factors and Prevention News Summit sets the path ahead for Alzheimer's ...

  14. [General practitioner burnout: risk factors].

    Dagrada, H; Verbanck, P; Kornreich, C


    This paper aims to review current knowledge on risk factors leading to burn-out of general practitioners, who are particularly concerned by burn-out, as 50% of them are being more or less affected. This article is based on bibliographic research covering literature between 1975 and 2010, using PUB MED software, medical books and articles. 44 articles were selected as dealing well with the aspects of the burn-out reviewed here. It seems established that stress precedes burnout symptoms. Theories investigating relationships between stress and work are presented. Exogenic stress (load and organization of work, emotional interaction with the patient, constraints, lack of recognition, conflicts between private and professional life) interacts with endogenous stress (idealism, (too much) acute feeling of responsibility, mood disorder, difficulty in collaborating, character, personality). Burn-out symptoms would appear preferentially when these two stresses coexist. Despite the wealth of publications, there is still a lack of knowledge of the causes of burn-out, requiring therefore increased research efforts, in order to improve the implementation of preventive measures, beneficial to the doctors as well as to their patients. PMID:22034773

  15. [Obesity as a risk factor for atrial fibrillation].

    Duraj, Iwona; Broncel, Marlena


    Atrial fibrillation (AF) and obesity is a growing problem of public health both in Poland and in the whole world. AF risk factors may be summarized as elderliness, male sex, smoking, hypertension, diabetes, obesity, coronary heart disease, heart failure, valvular heart disease, cardiac surgery. Once obesity is an independent, potentially modifiable risk factor for AF. The connection between obesity and atrial fibrillation is very up-to-date because of incremental prevalence, almost epidemic of obesity in the whole world. The probability of AF among obese patients increases with concomitant obstructive sleep apnea. Regardless many researches it hasn't been assessed yet how obesity itself predisposes to AF. It could be an effect of change in the atrial anatomy, the rise of atrial pressure, mechanical stretch, interstitial atrial fibrosis and disruption of atrial electric integrity. A great role is ascribed to inflammation, especially proinflammatory cytokines increased by adipocites of left atrial epicardial adiposity. PMID:26891428

  16. Prediction of delirium after cardiac surgery and the use of a risk checklist

    Koster, S.; Hensens, A.G.; Schuurmans, M.J.; Palen, van der J.A.M.


    Background: Delirium is a temporary mental disorder, which occurs frequently among patients who undergo cardiac surgery. Delirium prediction and its associated prevention is essential. In a previous study, a risk checklist for delirium was developed. Aims: The present study validated this checkli

  17. Vascular endothelial growth factor is crucial for erythropoietin-induced improvement of cardiac function in heart failure

    Westenbrink, B. Daan; Ruifrok, Willem-Peter T.; Voors, Adriaan A.; Tilton, Ronald G.; van Veldhuisen, Dirk J.; Schoemaker, Regien G.; van Gilst, Wiek H.; de Boer, Rudolf A.


    We intended to delineate the mechanisms of erythropoietin (EPO)-induced cardiac vascular endothelial growth factor (VEGF) production and to establish if VEGF is crucial for EPO-induced improvement of cardiac performance. The effects of EPO on VEGF expression were studied in cultured cardiac cells an

  18. Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective.

    Tikkanen, Jani T; Kenttä, Tuomas; Porthan, Kimmo; Huikuri, Heikki V; Junttila, M Juhani


    The identification of patients at risk for sudden cardiac death (SCD) is still a significant challenge to clinicians and scientists. Noninvasive identification of high-risk patients has been of great interest, and several ventricular depolarization and repolarization abnormalities in the standard 12-lead electrocardiogram (ECG) have been associated with increased vulnerability to lethal ventricular arrhythmias. Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population. In this review, we will discuss the current knowledge of the SCD risk with standard 12-lead ECG T wave abnormalities in the general population, and possible T wave changes in various cardiac conditions predisposing to SCD. PMID:26391699

  19. [Assessment of risk of sudden cardiac death in patients with hypertrophic cardiomyopathy].

    Attanasio, Philipp; Blaschke, Florian; Pieske, Burkert; Tschöpe, Carsten; Haverkamp, Wilhelm


    Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterized by left ventricular hypertrophy with or without concomitant outflow tract obstruction. Identification of patients with HCM who are at high risk of sudden cardiac death (SCD) is crucial as those patients are likely to benefit from an implantable cardioverter defibrillator (ICD). Based on the HCM Risk-SCD study published in 2013, that included 3675 HCM patients with 24 313 years of follow up, a new clinical risk prediction model for sudden cardiac death was developed. This model was included in the recently released 2014 ESC guidelines. This review summarizes the changes in the prediction model and the resulting recommendations and discusses potential risks and limitations of the new score. PMID:27404936

  20. Cerebrovascular disease in South Asia – Part II: Risk factors and prevention

    Vibha, Deepti; Prasad, Kameshwar


    In South Asian countries, conventional vascular risk factors like hypertension, diabetes mellitus, cardiac disease, smoking, obesity, atrial fibrillation are the dominant ones, while other aetiologies like rheumatic heart disease, infective meningitis-related infarcts and postpartum cerebral venous thrombosis also constitute a big fraction. This review discusses the evidence of prevalence of various risk factors in South Asian countries and possible measures to combat the rising burden of cer...

  1. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Siriphuwanun V


    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3

  2. Erythropoietin protects myocardin-expressing cardiac stem cells against cytotoxicity of tumor necrosis factor-{alpha}

    Madonna, Rosalinda [The Center for Cardiovascular Biology and Atherosclerosis Research, The University of Texas Health Science Center at Houston, Texas (United States); Institute of Cardiology, and Center of Excellence on Aging, ' G. d' Annunzio' University, Chieti (Italy); Shelat, Harnath; Xue, Qun; Willerson, James T. [The Center for Cardiovascular Biology and Atherosclerosis Research, The University of Texas Health Science Center at Houston, Texas (United States); The Texas Heart Institute at St. Luke' s Episcopal Hospital, Houston, Texas (United States); De Caterina, Raffaele [Institute of Cardiology, and Center of Excellence on Aging, ' G. d' Annunzio' University, Chieti (Italy); Geng, Yong-Jian, E-mail: [The Center for Cardiovascular Biology and Atherosclerosis Research, The University of Texas Health Science Center at Houston, Texas (United States); The Texas Heart Institute at St. Luke' s Episcopal Hospital, Houston, Texas (United States)


    Cardiac stem cells are vulnerable to inflammation caused by infarction or ischemic injury. The growth factor, erythropoietin (Epo), ameliorates the inflammatory response of the myocardium to ischemic injury. This study was designed to assess the role of Epo in regulation of expression and activation of the cell death-associated intracellular signaling components in cardiac myoblasts stimulated with the proinflammatory cytokine tumor necrosis factor (TNF)-{alpha}. Cardiac myoblasts isolated from canine embryonic hearts characterized by expression of myocardin A, a promyogenic transcription factor for cardiovascular muscle development were pretreated with Epo and then exposed to TNF-{alpha}. Compared to untreated cells, the Epo-treated cardiac myoblasts exhibited better morphology and viability. Immunoblotting revealed lower levels of active caspase-3 and reductions in iNOS expression and NO production in Epo-treated cells. Furthermore, Epo pretreatment reduced nuclear translocation of NF-{kappa}B and inhibited phosphorylation of inhibitor of kappa B (I{kappa}B) in TNF-{alpha}-stimulated cardiac myoblasts. Thus, Epo protects cardiac myocyte progenitors or myoblasts against the cytotoxic effects of TNF-{alpha} by inhibiting NF-{kappa}B-mediated iNOS expression and NO production and by preventing caspase-3 activation.

  3. Highly abnormal thermotests in familial dysautonomia suggest increased cardiac autonomic risk

    Hilz, M; Kolodny, E.; Neuner, I; Stemper, B; Axelrod, F


    OBJECTIVE—Patients with familial dysautonomia have an increased risk of sudden death. In some patients with familial dysautonomia, sympathetic cardiac dysfunction is indicated by prolongation of corrected QT (QTc) interval, especially during stress tests. As many patients do not tolerate physical stress, additional indices are needed to predict autonomic risk. In familial dysautonomia there is a reduction of both sympathetic neurons and peripheral small nerve fibres which...

  4. Apigenin ameliorates hypertension-induced cardiac hypertrophy and down-regulates cardiac hypoxia inducible factor-lα in rats.

    Zhu, Zeng-Yan; Gao, Tian; Huang, Yan; Xue, Jie; Xie, Mei-Lin


    Apigenin is a natural flavonoid compound that can inhibit hypoxia-inducible factor (HIF)-1α expression in cultured tumor cells under hypoxic conditions. Hypertension-induced cardiac hypertrophy is always accompanied by abnormal myocardial glucolipid metabolism due to an increase of HIF-1α. However, whether or not apigenin may ameliorate the cardiac hypertrophy and abnormal myocardial glucolipid metabolism remains unknown. This study aimed to examine the effects of apigenin. Rats with cardiac hypertrophy induced by renovascular hypertension were treated with apigenin 50-100 mg kg(-1) (the doses can be achieved by pharmacological or dietary supplementation for an adult person) by gavage for 4 weeks. The results showed that after treatment with apigenin, the blood pressure, heart weight, heart weight index, cardiomyocyte cross-sectional area, serum angiotensin II, and serum and myocardial free fatty acids were reduced. It is important to note that apigenin decreased the expression level of myocardial HIF-1α protein. Moreover, apigenin simultaneously increased the expression levels of myocardial peroxisome proliferator-activated receptor (PPAR) α, carnitine palmitoyltransferase (CPT)-1, and pyruvate dehydrogenase kinase (PDK)-4 proteins and decreased the expression levels of myocardial PPARγ, glycerol-3-phosphate acyltransferase genes (GPAT), and glucose transporter (GLUT)-4 proteins. These findings demonstrated that apigenin could improve hypertensive cardiac hypertrophy and abnormal myocardial glucolipid metabolism in rats, and its mechanisms might be associated with the down-regulation of myocardial HIF-1α expression and, subsequently increasing the expressions of myocardial PPARα and its target genes CPT-1 and PDK-4, and decreasing the expressions of myocardial PPARγ and its target genes GPAT and GLUT-4. PMID:26987380

  5. Engineering a growth factor embedded nanofiber matrix niche to promote vascularization for functional cardiac regeneration.

    Lakshmanan, Rajesh; Kumaraswamy, Priyadharshini; Krishnan, Uma Maheswari; Sethuraman, Swaminathan


    The major loss of tissue extracellular matrix (ECM) after myocardial ischemia is a serious burden that gradually leads to heart failure. Due to lack of available treatment methods to restore the cardiac function, various research strategies have come up to treat the ischemic myocardium. However these have met with limited success due to the complexity of the cardiac tissue, which exhibits a nanofibrous collagenous matrix with spatio-temporal localization of a combination of growth factors. To mimic the topographical and chemical cues of the natural cardiac tissue, we have fabricated a growth factor embedded nanofibrous scaffold through electrospinning. In our previous work, we have reported a nanofibrous matrix made of PLCL and PEOz with an average diameter of 500 nm. The scaffold properties were specifically characterized in vitro for cardio-compatibility. In the present study, we have loaded dual growth factors VEGF and bFGF in the nanofiber matrix and investigated its suitability for cardiac tissue engineering. The encapsulation and release of dual growth factors from the matrix were studied using XPS and ELISA. Bioactivity of the loaded growth factors towards proliferation and migration of endothelial cells (HUVECs) was evaluated through MTS and Boyden chamber assays respectively. The efficiency of growth factors on the nanofibrous matrix to activate signaling molecules was studied in HUVECs through gene expression analysis. Preclinical evaluation of the growth factor embedded nanofibrous patch in a rabbit acute myocardial infarction (AMI) model was studied and cardiac function assessment was made through ECG and echocardiography. The evidence for angiogenesis in the patch secured regions was analyzed through histopathology and immunohistochemistry. Our results confirm the effectiveness of growth factor embedded nanofiber matrix in restoration of cardiac function after ischemia when compared to conventional patch material thereby exhibiting promise as a

  6. What Are the Risk Factors for Gastrointestinal Stromal Tumors?

    ... what causes gastrointestinal stromal tumors? What are the risk factors for gastrointestinal stromal tumors? A risk factor is ... disease like cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like ...

  7. Non-sedating antihistamine drugs and cardiac arrhythmias -- biased risk estimates from spontaneous reporting systems?

    De Bruin, M L; van Puijenbroek, E P; Egberts, A C G;


    AIMS: This study used spontaneous reports of adverse events to estimate the risk for developing cardiac arrhythmias due to the systemic use of non-sedating antihistamine drugs and compared the risk estimate before and after the regulatory action to recall the over-the-counter status of some of...... patients were using non-sedating antihistamines. In general non-sedating antihistamines are associated with cardiac arrhythmia to a higher extent in comparison with other drugs (ADR reporting odds ratio 2.05 [95% CI: 1.45, 2.89]). The association between arrhythmias and non-sedating antihistamine drugs...... calculated before 1998 was not significantly higher than 1 (OR 1.37 [95% CI: 0.85, 2.23]), whereas the risk estimate calculated after the governmental decision did significantly differ from 1 (OR 4.19 [95% CI: 2.49, 7.05]). CONCLUSIONS: Our data suggest that non-sedating antihistamines might have an...

  8. Conversion factors for the estimation of effective dose in paediatric cardiac angiography

    Conversion factors, which relate the kerma-area product to effective dose, have been estimated for paediatric cardiac x-ray angiography. Monte Carlo techniques have been used to calculate the conversion factors for a wide range of projection angles for children of five ages and for adults. Correction factors are provided so that the conversion factors can be adjusted for different tube potentials and filtrations. (author)

  9. Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events

    Szepietowska, Barbara; Polonsky, Bronislava; Sherazi, Saadia; Biton, Yitschak; Kutyifa, Valentina; McNitt, Scott; AKTAS, Mehmet; Moss, Arthur J.; Zareba, Wojciech


    Background Obesity is associated with multiple adverse cardiovascular conditions and may increase the risk of ventricular tachyarrhythmias (VT/VF). There is limited data on the association between obesity and risk of VT/VF requiring appropriate implantable cardioverter-defibrillator (ICD) therapies and the effectiveness of cardiac resynchronization therapy (CRT) to reduce risk for VT/VF. The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-C...

  10. Developmental Risk Factors for Sexual Offending.

    Lee, Joseph K. P.; Jackson, Henry J.; Pattison, Pip; Ward, Tony


    A study involving 64 Australian sex offenders and 33 non-sex offenders found childhood emotional abuse and family dysfunction, childhood behavior problems, and childhood sexual abuse were developmental risk factors for paraphilia. Emotional abuse and family dysfunction was found to be a risk factor for pedophilia, exhibitionism, rape, or multiple…

  11. Anthracycline-related cardiotoxicity: risk factors and therapeutic options in childhood cancers



    Full Text Available Anthracyclines play an important role in chemotherapeutic regimens for a wide spectrum of childhood tumors, but they can cause cytotoxic damage to cardiac cells, especially in combination with radiotherapy. Furthermore, cardiotoxicity increases with the cumulative dose and may lead to congestive heart failure and cardiomyopathy. Other factors, including age, pre-existing cardiac disease, length of follow-up, gender, route of administration, concomitant exposure to some chemotherapeutic drugs, trisomy 21 and black race, play a role in increasing the risk of cardiac dysfunction. The prevention of anthracycline-induced cardiotoxicity is mandatory as children are expected to survive for decades after being cured of their cancer. The purpose of this work is to point out the major risk factors of cardiotoxicity in children and to summarize some strategies to limit or prevent this complication and to treat the development of acute heart failure.

  12. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

    Murtaza, Ghulam; Khan, Muhammad Yasir Ghani; Azhar, Saira; Khan, Shujaat Ali; Khan, Tahir M


    Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs. PMID:27013915


    LIU; Guo-jin


    [1]Wilkens Ew JR, Scannell JG, Graver JG. Four decades of experience with resections for bronchogenic carcinoma at the Massachusetts General Hospital [J]. J Thorac Cardiovasc Surg 1978; 76:364.[2]John Klemperer, Ginsberg RJ. Morbidity and mortality of the pneumonectomy [J]. Chest Surgery Clinic of North America 1999; 3:515.[3]Romano PS, Mark DH. Patient and hospital characteristics related to in-hospital mortality after cancer resetion [J]. Chest 1992; 101:133.[4]Krowka MJ, Pairolero PC, et al. Cardiac dysrhythmia following pneumonectomy. Clinical correlates and prognostic significance [J]. Chest 1987; 91:9.[5]Patel RL, Townsend ER, Fountain SW. Elective pneumonectomy: Factors associated with morbidity and operative mortality [J]. Ann Thorac Surg 1992; 54:84.[6]Swartz DE, Lachapellek, Sampalis J, et al. Perioperative Mortality of the pneumonectomy: Analysis of risk factors and review of Literature [J]. Can J Surg 1997; 40:4374.[7]Nagasaki F, Flehinger BJ, Mantini, et al. Complications of surgery in the treatment of carcinoma of the lung [J]. Chest 1982; 1:25.[8]Keagy BA, Schorlemer GR, Murray GF, et al. Correlation of preoperative pulmonary function testing with clinical course in patients after pneumonectomy [J]. Ann Thorac Surg 1983; 36:253.[9]LU Guo-qing, LI Cun-ling, WU Wei-ji, et al. Clinical analysis of 53 cases of lung cancer patients undergoing pneumonectomy [J]. Chin Surg 1987; 25:295.[10]Cheng Kailing, Xuan Cixin. Analysis of risk factors of cardiorespiratory complications after pneumonectomy for lung cancer [J]. Lung Cancer 1999; 2:41.[11]David H, Harpole JR, Michael J, et al. Prospective analysis of pneumonectomy: Risk factors for major morbity and cardiac dysrhythmias [J]. Ann Thorac Surg 1996; 61:977.

  14. AKI网络定义的急性肾损伤在心脏手术后患者中的发生情况及其危险因素和预后分析%Incidence of acute kidney injury according to AKI Network after cardiac surgery and analysis of risk factors and outcome

    车妙琳; 严玉澄; 郦忆; 梁馨月; 戴慧莉; 朱铭力; 顾乐怡; 钱家麒; 倪兆慧; 薛松


    目的 了解心脏手术后急性肾损伤(AKI)的发牛情况,危险因素及预后.方法 回顾性分析2004年1月1日至2007年6月30日期间所有在本院行心脏手术的住院患者的临床资料.采用AKI网络(AKI Network,AKIN)推荐的AKI定义评估心脏手术后AKI的患病率及住院病死率,对术前、术中、术后与AKI发生可能相关的危险因素进行分析.结果 总共1056例患者中,术后发生AKI者328例,患病率为31.06%.AKI患者的住院病死率显著高于非AKI患者(11.59%比0.69%,P<0.01).多因素Logistic逐步回归分析显示,高龄(每增加10岁,发生AKI的风险上升1.40倍)、术前高尿酸血症(OR=1.97)、术前左心功能不全(OR=2.53)、冠脉旁路移植术(CABG)联合瓣膜手术(OR=2.79)、手术时间延长(每增加1 h,发生AKI的风险上升1.43倍)、术后循环血容量不足(OR=11.08)是心脏手术后AKI发生的独立危险因素.结论 AKI是心脏手术后常见的并发症,AKI患者预后较差.高龄、术前高尿酸血症、术前左心功能不全、CABG联合瓣膜手术、手术时间延长、术后循环血容量不足是心脏手术后AKI发生的独立危险因素.%Objective To investigate the incidence, risk factors and outcome of acute kidney injury (AKI) following cardiac surgeries. Methods Clinical data of 1056 patients undergoing open heart surgery in Renji Hospital from January 2004 to June 2007 were retrospectively analyzed. Univariate and multivariate analyses were used to evaluate possible pre-,intra-, and post-operative parameters associated with AKI according to AKI Network (AKIN). Results Of the 1056 patients, 328 (31.06%) developed AKI. In-hospital mortality was 4.07% in all discharges while 11.59% in AKI patients (P<0.01). Multivariate logistic regression analysis revealed that increased age (OR=1.40), pre-operative hyperurieemia (OR=1.97), pre-operative left ventricular insufficiency (OR=2.53), combined surgery (OR=2.79), prolonged operation time (OR=1

  15. Seismic Risk Perception compared with seismic Risk Factors

    Crescimbene, Massimo; La Longa, Federica; Pessina, Vera; Pino, Nicola Alessandro; Peruzza, Laura


    The communication of natural hazards and their consequences is one of the more relevant ethical issues faced by scientists. In the last years, social studies have provided evidence that risk communication is strongly influenced by the risk perception of people. In order to develop effective information and risk communication strategies, the perception of risks and the influencing factors should be known. A theory that offers an integrative approach to understanding and explaining risk perception is still missing. To explain risk perception, it is necessary to consider several perspectives: social, psychological and cultural perspectives and their interactions. This paper presents the results of the CATI survey on seismic risk perception in Italy, conducted by INGV researchers on funding by the DPC. We built a questionnaire to assess seismic risk perception, with a particular attention to compare hazard, vulnerability and exposure perception with the real data of the same factors. The Seismic Risk Perception Questionnaire (SRP-Q) is designed by semantic differential method, using opposite terms on a Likert scale to seven points. The questionnaire allows to obtain the scores of five risk indicators: Hazard, Exposure, Vulnerability, People and Community, Earthquake Phenomenon. The questionnaire was administered by telephone interview (C.A.T.I.) on a statistical sample at national level of over 4,000 people, in the period January -February 2015. Results show that risk perception seems be underestimated for all indicators considered. In particular scores of seismic Vulnerability factor are extremely low compared with house information data of the respondents. Other data collected by the questionnaire regard Earthquake information level, Sources of information, Earthquake occurrence with respect to other natural hazards, participation at risk reduction activities and level of involvement. Research on risk perception aims to aid risk analysis and policy-making by

  16. Regulation of Cardiac Hypertrophy: the nuclear option

    Kuster, Diederik


    textabstractCardiac hypertrophy is the response of the heart to an increased workload. After myocardial infarction (MI) the surviving muscle tissue has to work harder to maintain cardiac output. This sustained increase in workload leads to cardiac hypertrophy. Despite its apparent appropriateness, cardiac hypertrophy is an independent risk factor for the development of heart failure and is therefore called pathological hypertrophy. That hypertrophy is not bad per se, is illustrated by the hyp...

  17. Cardiac Rehabilitation: Guidelines and Recommendations

    Catherine Monpere


    Cardiac rehabilitation has been shown to improve exercise tolerance and symptomatology in patients experiencing angina or heart failure and reduce long term mortality after myocardial infarction, with a good cost-effectiveness ratio. In addition to these `hard' endpoints, cardiac rehabilitation improves the patient's quality of life and risk factor profile through a multifactorial intervention. Indeed, cardiac rehabilitation is no longer restricted to physical reconditioning, but should now b...

  18. Traditional cardiovascular risk factors and coronary artery calcification in adults with polymyositis and dermatomyositis

    Diederichsen, Louise C. Pyndt Raun; Diederichsen, Axel C P; Simonsen, Jane A;


    OBJECTIVE: To determine the occurrence of traditional cardiovascular (CV) risk factors and coronary artery calcification (CAC) in adults with polymyositis (PM) or dermatomyositis (DM) compared to healthy controls and to assess the association between CV risk factors, PM/DM, and CAC score. METHODS......: Traditional CV risk factors were assessed in a cross-sectional, observational study of 76 patients with PM/DM and in 48 sex- and age-matched healthy controls. CAC was quantified by means of cardiac computed tomography scan and expressed in Agatston units. The associations between CV risk factors, PM/DM, and...... of triglycerides (P = 0.0009). High CAC score occurred more frequently in patients (20% versus 4%; P = 0.04). In multivariate analysis of patient factors associated with CAC were age (P = 0.02) and smoking (P = 0.02). CONCLUSION: In this study, traditional CV risk factors and severe CAC were commonly...

  19. Risk Assessment of Mortality Following Intraoperative Cardiac Arrest Using POSSUM and P-POSSUM in Adults Undergoing Non-Cardiac Surgery

    Kim, Shin Hyung; Kil, Hae Keum; Kim, Hye Jin; Koo, Bon-Nyeo


    Purpose The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. Materials and Methods...

  20. A Role for RE-1-Silencing Transcription Factor in Embryonic Stem Cells Cardiac Lineage Specification.

    Aksoy, Irene; Marcy, Guillaume; Chen, Jiaxuan; Divakar, Ushashree; Kumar, Vibhor; John-Sanchez, Daniel; Rahmani, Mehran; Buckley, Noel J; Stanton, Lawrence W


    During development, lineage specification is controlled by several signaling pathways involving various transcription factors (TFs). Here, we studied the RE-1-silencing transcription factor (REST) and identified an important role of this TF in cardiac differentiation. Using mouse embryonic stem cells (ESC) to model development, we found that REST knockout cells lost the ability to differentiate into the cardiac lineage. Detailed analysis of specific lineage markers expression showed selective downregulation of endoderm markers in REST-null cells, thus contributing to a loss of cardiogenic signals. REST regulates cardiac differentiation of ESCs by negatively regulating the Wnt/β-catenin signaling pathway and positively regulating the cardiogenic TF Gata4. We propose here a new role for REST in cell fate specification besides its well-known repressive role of neuronal differentiation. PMID:26864965

  1. Risk factors for respiratory syncytial virus hospitalisation in children with heart disease

    Kristensen, Kim; Stensballe, LG; Fisker, Niels;


    OBJECTIVE: To assess the risk and risk factors for respiratory syncytial virus (RSV) hospitalisation and determinants of the severity of RSV disease in children with heart disease. METHODS: By using a database on RSV tests in Denmark all children with RSV diagnosed with heart disease in Denmark...... hospitalisation predictors of the need for respiratory support (supplemental oxygen, nasal continuous positive airway pressure or mechanical ventilation) were young age (relative risk (RR) 0.47, 95% CI 0.32 to 0.67 per additional year of age) and cardiac decompensation (RR 1.81, 95% CI 1.02 to 3.......23). The incidence rate of RSV hospitalisation among children with any heart disease aged 0-23 months was 5.65 per 100 child-years. CONCLUSION: In children with heart disease risk factors for RSV admission are Down syndrome, cardiomyopathy and haemodynamically significant heart disease. Young age and cardiac...

  2. Fibroblast growth factor 21 as a possible endogenous factor inhibits apoptosis in cardiac endothelial cells

    L(U) Yun; ZHANG Ying-chuan; LIU Jing-hua; ZHANG Li-ke; DU Jie; ZENG Xiang-jun; HAO Gang; HUANG Ji; ZHAO Dong-hui; WANG Guo-zhong


    Background Fibroblast growth factor 21 (FGF21) is a new member of FGF super family that is an important endogenous regulator for systemic glucose and lipid metabolism. This study aimed to explore whether FGF21 reduces atherosclerotic injury and prevents endothelial dysfunction as an independent protection factor.Methods The present study was designed to investigate the changes of FGF21 levels induced by oxidized-low density lipoprotein (ox-LDL), and the changes of apoptosis affected by regulating FGF21 expression. The FGF21 mRNA levels of cultured cardiac microvascular endothelial cells (CMECs) were determined by real time-PCR and the protein concentration in culture media was detected by enzyme-linked immunosorbent assay. We analyzed the different expression levels of untreated controls and CMFCs incubated with ox-LDL, and the changes of CMECs apoptosis initiated by the enhancement or suppression of FGF21 levels.Results The secretion levels of FGF21 mRNA and protein were significantly upregulated in CMECs incubated with ox-LDL. Furthermore, FGF21 levels increased by 200 μmol/L bezafibrate could reduce CMECs apoptosis, and inhibit FGF21 expression by shRNA induced apoptosis (P <0.05).Conclusions FGF21 may be a signal of injured target tissue, and may play physiological roles in improving the endothelial function at an early stage of atherosclerosis and in stopping the development of coronary heart disease.

  3. Circadian misalignment increases cardiovascular disease risk factors in humans.

    Morris, Christopher J; Purvis, Taylor E; Hu, Kun; Scheer, Frank A J L


    Shift work is a risk factor for hypertension, inflammation, and cardiovascular disease. This increased risk cannot be fully explained by classic risk factors. One of the key features of shift workers is that their behavioral and environmental cycles are typically misaligned relative to their endogenous circadian system. However, there is little information on the impact of acute circadian misalignment on cardiovascular disease risk in humans. Here we show-by using two 8-d laboratory protocols-that short-term circadian misalignment (12-h inverted behavioral and environmental cycles for three days) adversely affects cardiovascular risk factors in healthy adults. Circadian misalignment increased 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 3.0 mmHg and 1.5 mmHg, respectively. These results were primarily explained by an increase in blood pressure during sleep opportunities (SBP, +5.6 mmHg; DBP, +1.9 mmHg) and, to a lesser extent, by raised blood pressure during wake periods (SBP, +1.6 mmHg; DBP, +1.4 mmHg). Circadian misalignment decreased wake cardiac vagal modulation by 8-15%, as determined by heart rate variability analysis, and decreased 24-h urinary epinephrine excretion rate by 7%, without a significant effect on 24-h urinary norepinephrine excretion rate. Circadian misalignment increased 24-h serum interleukin-6, C-reactive protein, resistin, and tumor necrosis factor-α levels by 3-29%. We demonstrate that circadian misalignment per se increases blood pressure and inflammatory markers. Our findings may help explain why shift work increases hypertension, inflammation, and cardiovascular disease risk. PMID:26858430

  4. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F;


    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were...... identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an OHCA; 2,913 (15.2%) were receiving antidepressant treatment at the time of OHCA, with citalopram...... being the most frequently used type of antidepressant (50.8%). Tricyclic antidepressants (TCAs; odds ratio (OR) = 1.69, confidence interval (CI): 1.14-2.50) and selective serotonin reuptake inhibitors (SSRIs; OR = 1.21, CI: 1.00-1.47) were both associated with comparable increases in risk of OHCA...

  5. A Psychological Factor Affecting a Cardiac Condition in a Psychotherapist

    R Waxman


    Full Text Available It has been established that intense emotions can affect the development and course of cardiac arrhythmias. This study sought to convey that a lack of expression of emotion can also have an effect on arrhythmias. A psychotherapist with Idiopathic Ventricular Fibrillation and an Implantable Cardioverter Defibrillator measured his rate of Premature Ventricular Contractions using a Holter monitor during three separate six-week periods and in three domains: A work days vs. off days, B a 27 hour work week vs. 22 hour work week, and C in 5 different modalities including 1 Meeting with department head 2 Individual psychotherapy with patients 3 Group therapy with patients 4 Supervision of residents 5 Personal psychoanalysis. The results showed more than a 3-fold increase of arrhythmogenic activity during the 27-hour work week vs. 22 and a 5-fold increase in arrhythmogenic activity on work days compared to days off. Department Head meetings were found to be most arrhythmogenic and personal psychoanalysis was least. The data suggest that the psychiatrist’s lack of emotional expression in his clinical work has been demonstrated to markedly worsen his arrhythmia. The results also point to the potential ameliorating effects of the therapist’s own psychotherapy.

  6. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    Dover, Mary


    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  7. Preoperative evaluation of cardiac risk by means of atrial pacing and thallium 201 scintigraphy

    Atrial pacing and thallium 201 scintigraphy were done in 61 patients with known or suspected coronary artery disease referred for evaluation of cardiac risk before elective vascular surgery. All patients had noncardiac limitations precluding performance of an adequate exercise stress test. Before atrial pacing all were considered to be at low risk of a postoperative cardiac event based on assessment of clinical parameters. Vascular surgery was subsequently performed in 47 patients. In these patients, pacing-induced ST segment depression greater than or equal to 1 mm occurred in 18, a fixed perfusion defect occurred in 11, and a reversible defect occurred in six. Two of the six patients with reversible perfusion defects had preoperative coronary angiography; both had significant coronary artery disease (one or more lesions greater than or equal to 50%). Two patients (one of whom had a reversible perfusion defect) underwent preoperative coronary revascularization and tolerated subsequent vascular surgery well. All other patients received only medical therapy. None of the 47 patients undergoing vascular surgery had a postoperative cardiac event (unstable angina, congestive heart failure, myocardial infarction, or cardiac death). Of the 14 patients in whom vascular surgery was deferred or canceled, surgery was canceled for noncardiac reasons in seven. Six of these seven patients had a normal perfusion scan; none had a reversible perfusion defect or marked (greater than or equal to 2 mm) ST segment depression. No cardiac event occurred during a 3-month period after atrial pacing in any of these patients. Six of the remaining seven patients had reversible perfusion defects

  8. Ectasia risk factors in refractive surgery

    Santhiago MR


    Full Text Available Marcony R Santhiago,1 Natalia T Giacomin,1 David Smadja,2 Samir J Bechara1 1Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil, 2Ophthalmology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Abstract: This review outlines risk factors of post-laser in situ keratomileusis (LASIK ectasia that can be detected preoperatively and presents a new metric to be considered in the detection of ectasia risk. Relevant factors in refractive surgery screening include the analysis of intrinsic biomechanical properties (information obtained from corneal topography/tomography and patient’s age, as well as the analysis of alterable biomechanical properties (information obtained from the amount of tissue altered by surgery and the remaining load-bearing tissue. Corneal topo­graphy patterns of placido disk seem to play a pivotal role as a surrogate of corneal strength, and abnormal corneal topography remains to be the most important identifiable risk factor for ectasia. Information derived from tomography, such as pachymetric and epithelial maps as well as computational strategies, to help in the detection of keratoconus is additional and relevant. High percentage of tissue altered (PTA is the most robust risk factor for ectasia after LASIK in patients with normal preoperative corneal topography. Compared to specific residual stromal bed (RSB or central corneal thickness values, percentage of tissue altered likely provides a more individualized measure of biomechanical alteration because it considers the relationship between thickness, tissue altered through ablation and flap creation, and ultimate RSB thickness. Other recognized risk factors include low RSB, thin cornea, and high myopia. Age is also a very important risk factor and still remains as one of the most overlooked ones. A comprehensive screening approach with the Ectasia Risk Score System, which evaluates multiple risk factors simultaneously, is also a


    Prostate cancer has the highest prevalence of any non-skin cancer in the human body, with similar likelihood of neoplastic foci found within the prostates of men around the world regardless of diet, occupation, lifestyle, or other factors. Essentially all men with circulating an...

  10. Uncertainty factors in ectotoxicological risk : uncertainty factors in ectotoxicological risk management.

    Craig, P.


    Uncertainty factors (also known as extrapolation or safety factors) are widely used in lower tier ecotoxicological risk management in order to allow for sources of variability and uncertainty for which there is only limited information. From the point of view of probabilistic risk assessment, the rationale underlying both the use of uncertainty factors and the specific values chosen is often unclear. On the other hand, uncertainty factors are a convenient approach to lower tier risk assessme...