WorldWideScience

Sample records for future coronary events

  1. Coronary CT: clinical indications and future directions

    International Nuclear Information System (INIS)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B.; Cury, Roberto C.

    2011-01-01

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  2. (n-3) Fatty acid content of red blood cells does not predict risk of future cardiovascular events following an acute coronary syndrome.

    Science.gov (United States)

    Aarsetoey, Hildegunn; Pönitz, Volker; Grundt, Heidi; Staines, Harry; Harris, William S; Nilsen, Dennis W T

    2009-03-01

    A reduced risk of fatal coronary artery disease has been associated with a high intake of (n-3) fatty acids (FA) and a direct cardioprotective effect by their incorporation into myocardial cells has been suggested. Based on these observations, the omega-3 index (eicosapentaenoic acid + docosahexaenoic acid in cell membranes of RBC expressed as percent of total FA) has been suggested as a new risk marker for cardiac death. In this study, our aim was to evaluate the omega-3 index as a prognostic risk marker following hospitalization with an acute coronary syndrome (ACS). The omega-3 index was measured at admission in 460 patients with an ACS as defined by Troponin-T (TnT) > or = 0.02 microg/L. During a 2-y follow-up, recurrent myocardial infarctions (MI) (defined as TnT > 0.05 microg/L with a typical MI presentation) and cardiac and all-cause mortality were registered. Cox regression analyses were used to relate the risk of new events to the quartiles of the omega-3 index at inclusion. After correction for age, sex, previous heart disease, hypertension, diabetes, smoking, high-sensitivity C-reactive protein, brain natriuretic peptide, creatinine, total cholesterol, HDL-cholesterol, triacylglycerol, homocysteine, BMI, and medication, there was no significant reduction in risk for all-cause mortality, cardiac death, or MI with increasing values of the index. In conclusion, we could not confirm the omega-3 index as a useful prognostic risk marker following an ACS.

  3. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

    Science.gov (United States)

    Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

    2017-08-01

    Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

  4. Effect of darapladib on major coronary events after an acute coronary syndrome

    DEFF Research Database (Denmark)

    O'Donoghue, Michelle L; Braunwald, Eugene; White, Harvey D

    2014-01-01

    ]) at 868 sites in 36 countries. INTERVENTIONS: Patients were randomized to either once-daily darapladib (160 mg) or placebo on a background of guideline-recommended therapy. Patients were followed up for a median of 2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES AND MEASURES......: The primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years. RESULTS: During a median duration of 2.5 years, the primary end point occurred in 903...

  5. Coronary CT: clinical indications and future directions; Tomografia de coronarias: indicacoes clinicas e perspectivas futuras

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B., E-mail: cesarnomura@gmail.com [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Cury, Roberto C. [Hospital Samaritano, Sao Paulo, SP (Brazil)

    2011-01-15

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  6. Darapladib for preventing ischemic events in stable coronary heart disease

    NARCIS (Netherlands)

    White, Harvey D.; Held, Claes; Stewart, Ralph; Tarka, Elizabeth; Brown, Rebekkah; Davies, Richard Y.; Budaj, Andrzej; Harrington, Robert A.; Steg, P. Gabriel; Ardissino, Diego; Armstrong, Paul W.; Avezum, Alvaro; Aylward, Philip E.; Bryce, Alfonso; Chen, Hong; Chen, Ming-Fong; Corbalan, Ramon; Dalby, Anthony J.; Danchin, Nicolas; de Winter, Robbert J.; Denchev, Stefan; Diaz, Rafael; Elisaf, Moses; Flather, Marcus D.; Goudev, Assen R.; Granger, Christopher B.; Grinfeld, Liliana; Hochman, Judith S.; Husted, Steen; Kim, Hyo-Soo; Koenig, Wolfgang; Linhart, Ales; Lonn, Eva; López-Sendón, José; Manolis, Athanasios J.; Mohler, Emile R.; Nicolau, José C.; Pais, Prem; Parkhomenko, Alexander; Pedersen, Terje R.; Pella, Daniel; Ramos-Corrales, Marco A.; Ruda, Mikhail; Sereg, Mátyás; Siddique, Saulat; Sinnaeve, Peter; Smith, Peter; Sritara, Piyamitr; Swart, Henk P.; Westendorp, Iris C. D.

    2014-01-01

    Elevated lipoprotein-associated phospholipase A2 activity promotes the development of vulnerable atherosclerotic plaques, and elevated plasma levels of this enzyme are associated with an increased risk of coronary events. Darapladib is a selective oral inhibitor of lipoprotein-associated

  7. Non-obstructive low attenuation coronary plaque predicts three-year acute coronary syndrome events in patients with hypertension. Multidetector computed tomographic study

    International Nuclear Information System (INIS)

    Nakanishi, Koki; Shimada, Kenei; Fukuda, Shota

    2012-01-01

    Arterial hypertension is an established risk factor for acute coronary syndrome (ACS). Multidetector computed tomography (MDCT) is an accurate and less invasive technique for assessment of the degree of coronary artery luminal narrowing and characterization of coronary atherosclerosis. We therefore aimed to investigate the predictive power of MDCT for future ACS events and compared with traditional parameters in patients with hypertension. One hundred and thirty-four patients (93 men, mean age 70±11 years) with hypertension underwent MDCT for evaluation of coronary artery disease. MDCT analysis focused on the presence of plaques, the degree of stenosis, and the plaque characteristics. Traditional parameters included Framingham risk score, carotid intima-media thickness, and left ventricular mass index. During a mean follow-up of 39±10 months, ACS events occurred in 10 patients, including myocardial infarction (n=3) and unstable angina (n=7). Multivariate analysis identified total number of low attenuation plaques as an independent predictor of ACS events (p<0.001). We demonstrated that non-obstructive low attenuation coronary plaques on MDCT predicted more accurately future ACS events in patients with hypertension than traditional parameters. (author)

  8. Medical and sociodemographic factors predict persistent smoking after coronary events.

    Science.gov (United States)

    Sverre, Elise; Otterstad, Jan Erik; Gjertsen, Erik; Gullestad, Lars; Husebye, Einar; Dammen, Toril; Moum, Torbjørn; Munkhaugen, John

    2017-09-06

    Understanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events. A cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied. At the index hospitalization, 390 patients were smoking and at follow-up after 2-36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1-10 Likert scale). Low socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids. Registered at ClinicalTrials.gov: NCT02309255 , registered retrospectively.

  9. Paraoxonase 1 (Q192R) gene polymorphism, coronary heart disease and the risk of a new acute coronary event.

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna; Medina-Gil, José María; Garay-Sánchez, Paloma; Tugores, Antonio

    Paraoxonase 1 (PON1) plays a major role in the oxidation of low density lipoprotein and in the prevention of coronary atherogenesis. In this context, coding region polymorphisms of PON1 gene, responsible for the enzyme activity, has become of interest as a marker for atherogenesis. A study and follow-up was conducted on 529 patients with an acute coronary event in order to assess the association between the PON1 Q192R (rs662;A/G) polymorphism, the type of acute coronary syndrome, cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidaemia, and smoking), the extent and severity of coronary atherosclerosis, and the medium-term clinical follow-up. The QQ genotype was found in 245 (46.3%) patients, with 218 (41.2%) patients showing the QR genotype, and 66 (14.5%) patients had the RR genotype. No significant differences were found between the QQ and QR/RR genotypes as regards the clinical characteristics, the analytical data, and the angiographic variables. Similarly, Kaplan-Meier survival analysis showed no significant differences in presenting with a new acute coronary event (p=0.598), cardiac mortality (p=0.701), stent thrombosis (p=0.508), or stent re-stenosis (p=0.598) between QQ and QR/RR genotypes during the follow-up period (3.3±2.2 years). In patients with an acute coronary syndrome, the PON1 Q192R genotypes did not influence the risk of suffering a new acute coronary event during the medium-term follow-up. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation

    Directory of Open Access Journals (Sweden)

    Michael Diodato

    2014-01-01

    Full Text Available The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization.

  11. Long term exposure to ambient air pollution and incidence of acute coronary events

    DEFF Research Database (Denmark)

    Cesaroni, Giulia; Forastiere, Francesco; Stafoggia, Massimo

    2014-01-01

    To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).......To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE)....

  12. Gender differences in the implementation of cardiovascular prevention measures after an acute coronary event

    OpenAIRE

    Dallongeville, Jean; De Bacquer, Dirk; Heidrich, Jan; De Backer, Gui; Prugger, Christoph; Kotseva, Kornelia; Montaye, Michèle; Amouyel, Philippe

    2010-01-01

    Objective To compare gender-related lifestyle changes and risk factor management after hospitalisation for a coronary event or revascularisation intervention in Europe. Method The EUROASPIRE III survey was carried out in 22 European countries in 2006-2007. Consecutive patients having had a coronary event or revascularisation before the age of 80 were identified. A total of 8966 patients (25.3% women) were interviewed and underwent clinical and biochemical tests at least 6 months after hosp...

  13. Metabolic syndrome and the risk of adverse cardiovascular events after an acute coronary syndrome.

    Science.gov (United States)

    Cavallari, Ilaria; Cannon, Christopher P; Braunwald, Eugene; Goodrich, Erica L; Im, KyungAh; Lukas, Mary Ann; O'Donoghue, Michelle L

    2018-05-01

    Background The incremental prognostic value of assessing the metabolic syndrome has been disputed. Little is known regarding its prognostic value in patients after an acute coronary syndrome. Design and methods The presence of metabolic syndrome (2005 International Diabetes Federation) was assessed at baseline in SOLID-TIMI 52, a trial of patients within 30 days of acute coronary syndrome (median follow-up 2.5 years). The primary endpoint was major coronary events (coronary heart disease death, myocardial infarction or urgent coronary revascularization). Results At baseline, 61.6% ( n = 7537) of patients met the definition of metabolic syndrome, 34.7% (n = 4247) had diabetes and 29.3% had both ( n = 3584). The presence of metabolic syndrome was associated with increased risk of major coronary events (adjusted hazard ratio (adjHR) 1.29, p metabolic syndrome was numerically but not significantly associated with the risk of major coronary events (adjHR 1.13, p = 0.06). Conversely, diabetes was a strong independent predictor of major coronary events in the absence of metabolic syndrome (adjHR 1.57, p metabolic syndrome identified patients at highest risk of adverse outcomes but the incremental value of metabolic syndrome was not significant relative to diabetes alone (adjHR 1.07, p = 0.54). Conclusions After acute coronary syndrome, diabetes is a strong and independent predictor of adverse outcomes. Assessment of the metabolic syndrome provides only marginal incremental value once the presence or absence of diabetes is established.

  14. Population assessment of future trajectories in coronary heart disease mortality.

    Directory of Open Access Journals (Sweden)

    Rosa Björk Thorolfsdottir

    Full Text Available BACKGROUND: Coronary heart disease (CHD mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. METHODS AND FINDINGS: The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25-74. Calculations were based on combining: i data on population numbers and projections (Statistics Iceland, ii population risk factor levels and projections (Refine Reykjavik study, and iii effectiveness of specific risk factor reductions (published meta-analyses. Projections for three contrasting scenarios were compared: (1 If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. (2 If recent trends in risk factors (past 5 years continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3 Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040. CONCLUSIONS: The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future.

  15. Smoking restrictions and hospitalization for acute coronary events in Germany

    Science.gov (United States)

    Sargent, James D.; Demidenko, Eugene; Malenka, David J.; Li, Zhongze; Gohlke, Helmut

    2013-01-01

    Aims To study the effects of smoking restrictions in Germany on coronary syndromes and their associated costs. Methods and results All German states implemented laws partially restricting smoking in the public and hospitality sectors between August 2007 and July 2008. We conducted a before-and-after study to examine trends for the hospitalization rate for angina pectoris and acute myocardial infarction (AMI) for an insurance cohort of 3,700,384 individuals 30 years and older. Outcome measures were hospitalization rates for coronary syndromes, and hospitalization costs. Mean age of the cohort was 56 years, and two-thirds were female. Some 2.2 and 1.1% persons were hospitalized for angina pectoris and AMI, respectively, during the study period from January 2004 through December 2008. Law implementation was associated with a 13.3% (95% confidence interval 8.2, 18.4) decline in angina pectoris and an 8.6% (5.0, 12.2) decline in AMI after 1 year. Hospitalization costs also decreased significantly for the two conditions—9.6% (2.5, 16.6) for angina pectoris and 20.1% (16.0, 24.2) for AMI at 1 year following law implementation. Assuming the law caused the observed declines, it prevented 1,880 hospitalizations and saved 7.7 million Euros in costs for this cohort during the year following law implementation. Conclusions Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany. PMID:22350716

  16. Smoking restrictions and hospitalization for acute coronary events in Germany.

    Science.gov (United States)

    Sargent, James D; Demidenko, Eugene; Malenka, David J; Li, Zhongze; Gohlke, Helmut; Hanewinkel, Reiner

    2012-03-01

    To study the effects of smoking restrictions in Germany on coronary syndromes and their associated costs. All German states implemented laws partially restricting smoking in the public and hospitality sectors between August 2007 and July 2008. We conducted a before-and-after study to examine trends for the hospitalization rate for angina pectoris and acute myocardial infarction (AMI) for an insurance cohort of 3,700,384 individuals 30 years and older. Outcome measures were hospitalization rates for coronary syndromes, and hospitalization costs. Mean age of the cohort was 56 years, and two-thirds were female. Some 2.2 and 1.1% persons were hospitalized for angina pectoris and AMI, respectively, during the study period from January 2004 through December 2008. Law implementation was associated with a 13.3% (95% confidence interval 8.2, 18.4) decline in angina pectoris and an 8.6% (5.0, 12.2) decline in AMI after 1 year. Hospitalization costs also decreased significantly for the two conditions-9.6% (2.5, 16.6) for angina pectoris and 20.1% (16.0, 24.2) for AMI at 1 year following law implementation. Assuming the law caused the observed declines, it prevented 1,880 hospitalizations and saved 7.7 million Euros in costs for this cohort during the year following law implementation. Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany.

  17. High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event

    DEFF Research Database (Denmark)

    Mehlsen, Jesper; Wiinberg, Niels; Joergensen, Bjarne S

    2010-01-01

    The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiov......The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention...

  18. Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes

    DEFF Research Database (Denmark)

    Schoos, Mikkel; Mehran, Roxana; Dangas, George D

    2016-01-01

    quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7....... Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded...

  19. Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Shilane, David; Go, Alan S

    2014-01-01

    BACKGROUND: The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). OBJECTIVES: The purpose of this study was to assess the association of beta-blockers with outcomes among...... patients with new-onset CHD. METHODS: We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time......-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (pint) to determine whether the association differed for patients with or without a recent MI. RESULTS: A total of 26,793 patients were included, 19...

  20. THE EFFECT OF PHYSICAL ACTIVITY ON INFLAMMATORY MARKERS.THE RISK OF NEW CORONARY EVENT IN CORONARY HEART DISEASE PATIENTS

    Directory of Open Access Journals (Sweden)

    Todorka Savic

    2007-12-01

    Full Text Available Inflammation is an important factor in the pathogenesis of atherosclerosis, and several markers of inflammation have been associated with an increased risk of cardiovascular events. Physical activity may lower the risk of coronary heart disease(CHD by mitigating inflammation. The aim of the study was to investigate the effects of aerobic exercise training on systemic inflammatory response in patients with stabile coronary artery disease participating in a cardiovascular rehabilitation exercise program. Male (n=29 and female (n=23 patients with stable coronary heart disease were recruited for this study. All patients were divided into two groups: group with regular aerobic physical training during cardiovascular rehabilitation program phase II along 3 weeks in rehabilitation center and 3 weeks after that in home of patients and sedentary lifestyle group. There were no significant differences in gender distribution among analyzed groups. Student’s t test showed no significant difference in mean age, waist circumference (OS and waist/hip ratio (WHR. Degree of obesity was measured by BMI, and there was a significant improvement in BMI in patients who underwent the six-week physical training compared to control group (p<0.05.Physical training during 6 weeks did not show any effects on leukocyte count and ICAM-1 levels compared to control group. The exercise training induced reduction in plasma CRP levels by 23.72%, p<0.001, and reduction in plasma VCAM-1 levels by Moderate aerobic exercise training resulted in a significant reduction of inflammatory state by decreasing CRP and VCAM-1 levels without significant body mass and visceral obesity reduction. The obtained results indicate that regular physical activity is clinically attractive in primary and secondary prevention of coronary heart diseases.

  1. Mental Health and Stressful Life Events in Coronary Heart Disease Patients and Non- Patients

    Directory of Open Access Journals (Sweden)

    Samaneh Nateghian

    2008-07-01

    Full Text Available "nObjective: "n The main goal of this study is to compare stressful life events and mental health in coronary heart disease (CHD patients and non-patients. "nMethod: In this research, 120 participants (n=68 male, n= 52 female were divided into two groups of patients (n=60 and non-patients (n=60. They were selected from Vali Asr Hospital of Meshginshahr (Iran and completed the  General Health Questionnaire (GHQ and Stressful Life Events Inventory . "nResults: Data was analyzed using independent t-test. The results showed significant differences between CHD patients and non-patients in mental health and stressful life events. CHD patients showed high rates of physical symptoms and anxiety of GHQ . "nConclusion: CHD patients reported more stressful life events. Therefore, it can be inferred that psychological factors are important in coronary heart disease.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2015-09-15

    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.)

  3. Coronary artery disease in Brazil: contemporary management and future perspectives.

    Science.gov (United States)

    Polanczyk, C A; Ribeiro, J P

    2009-06-01

    Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

  4. Highly sensitive C-reactive protein and male gender are independently related to the severity of coronary disease in patients with metabolic syndrome and an acute coronary event

    Directory of Open Access Journals (Sweden)

    C.M.C. Monteiro

    2010-03-01

    Full Text Available Patients with metabolic syndrome are at high-risk for development of atherosclerosis and cardiovascular events. The objective of this study was to examine the major determinants of coronary disease severity, including those coronary risk factors associated with metabolic syndrome, during the early period after an acute coronary episode. We tested the hypothesis that inflammatory markers, especially highly sensitive C-reactive protein (hsCRP, are related to coronary atherosclerosis, in addition to traditional coronary risk factors. Subjects of both genders aged 30 to 75 years (N = 116 were prospectively included if they had suffered a recent acute coronary syndrome (acute myocardial infarction or unstable angina pectoris requiring hospitalization and if they had metabolic syndrome diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III. Patients were submitted to a coronary angiography and the burden of atherosclerosis was estimated by the Gensini score. The severity of coronary disease was correlated (Spearman’s or Pearson’s coefficient with gender (r = 0.291, P = 0.008, age (r = 0.218, P = 0.048, hsCRP (r = 0.256, P = 0.020, ApoB/ApoA ratio (r = 0.233, P = 0.041, and carotid intima-media thickness (r = 0.236, P = 0.041. After multiple linear regression, only male gender (P = 0.046 and hsCRP (P = 0.012 remained independently associated with the Gensini score. In this high-risk population, male gender and high levels of hsCRP, two variables that can be easily obtained, were associated with more extensive coronary disease, identifying patients with the highest potential of developing new coronary events.

  5. Usefulness of Coronary Atheroma Burden to Predict Cardiovascular Events in Patients Presenting With Acute Coronary Syndromes (from the PROSPECT Study).

    Science.gov (United States)

    Shan, Peiren; Mintz, Gary S; McPherson, John A; De Bruyne, Bernard; Farhat, Naim Z; Marso, Steven P; Serruys, Patrick W; Stone, Gregg W; Maehara, Akiko

    2015-12-01

    We investigated the relation between overall atheroma burden and clinical events in the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study. In PROSPECT, 660 patients (3,229 nonculprit lesions with a plaque burden ≥ 40% and complete intravascular ultrasound data) were divided into tertiles according to baseline percent atheroma volume (PAV: total plaque/vessel volume). Patients were followed for 3.4 years (median); major adverse cardiac events (MACE: death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization because of unstable or progressive angina) were adjudicated to either culprit or nonculprit lesions. Compared with patients in low or intermediate PAV tertiles, patients in the high PAV tertile had the greatest prevalence of plaque rupture and radiofrequency thin-cap fibroatheroma (VH-TCFA) and the highest percentage of necrotic core volume; they were also more likely to have high-risk lesion characteristics: ≥ 1 lesion with minimal luminal area ≤ 4 mm(2), plaque burden >70%, and/or VH-TCFA. Three-year cumulative nonculprit lesion-related MACE was greater in the intermediate and high tertiles than in the low tertile (6.3% vs 14.7% vs 15.1%, low vs intermediate vs high tertiles, p = 0.009). On Cox multivariable analysis, insulin-dependent diabetes (hazard ratio [HR] 3.98, p = 0.002), PAV (HR 1.06, p = 0.03), and the presence of ≥1 VH-TCFA (HR 1.80, p = 0.02) were independent predictors of nonculprit MACE. In conclusion, increasing baseline overall atheroma burden was associated with more advanced, complex, and vulnerable intravascular ultrasound lesion morphology and independently predicted nonculprit lesion-related MACE in patients with acute coronary syndromes after successful culprit lesion intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Fractional Flow Reserve Measurement by Coronary Computed Tomography Angiography: A Review with Future Directions

    Directory of Open Access Journals (Sweden)

    Asim Rizvi

    2016-12-01

    Full Text Available Invasive fractional flow reserve (FFR measurement is currently the gold standard for coronary intervention. FFR measurement by coronary computed tomography angiography (FFRCT is a novel and promising imaging technology that permits noninvasive assessment of physiologically significant coronary lesions. FFRCT is capable of combining the anatomic information provided by coronary computed tomography angiography with computational fluid dynamics to compute FFR. To date, several studies have reported the diagnostic performance of FFRCT compared with invasive FFR measurement as the reference standard. Further studies are now being implemented to determine the clinical feasibility and economic implications of FFRCT techniques. This article provides an overview and discusses the available evidence as well as potential future directions of FFRCT.

  7. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Zhao, Na; Mi, Lan; Liu, Xiaojun; Pan, Shuo; Xu, Jiaojiao; Xia, Dongyu; Liu, Zhongwei; Zhang, Yong; Xiang, Yu; Yuan, Zuyi; Guan, Gongchang; Wang, Junkui

    2015-01-01

    Global Registry of Acute Coronary Events (GRACE) risk score and red blood cell distribution width (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p risk of MACEs increased with increasing RDW content (p value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

  8. Current but not past smoking increases the risk of cardiac events: Insights from coronary computed tomographic angiography

    NARCIS (Netherlands)

    R. Nakanishi (Rine); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); H. Gransar (Heidi); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor Y.); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); R.C. Cury (Ricardo); A. Delago (Augustin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); F.Y. Lin (Fay); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); A. Dunning (Allison); J.K. Min (James)

    2015-01-01

    textabstractAims We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA). Methods and results We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588

  9. Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events.

    OpenAIRE

    Fox, KA; Carruthers, K; Steg, PG; Avezum, A; Granger, CB; Montalescot, G; Goodman, SG; Gore, JM; Quill, AL; Eagle, KA; GRACE Investigators,

    2010-01-01

    08.09.14 KB. Ok to add published version to spiral, OA paper AIMS: To determine whether changes in practice, over time, are associated with altered rates of major bleeding in acute coronary syndromes (ACS). METHODS AND RESULTS: Patients from the Global Registry of Acute Coronary Events were enrolled between 2000 and 2007. The main outcome measures were frequency of major bleeding, including haemorrhagic stroke, over time, after adjustment for patient characteristics, and impact of major b...

  10. Gender differences in the implementation of cardiovascular prevention measures after an acute coronary event.

    Science.gov (United States)

    Dallongevillle, Jean; De Bacquer, Dirk; Heidrich, Jan; De Backer, Guy; Prugger, Christoph; Kotseva, Kornelia; Montaye, Michèle; Amouyel, Philippe

    2010-11-01

    To compare gender-related lifestyle changes and risk factor management after hospitalisation for a coronary event or revascularisation intervention in Europe. The EUROASPIRE III survey was carried out in 22 European countries in 2006-2007. Consecutive patients having had a coronary event or revascularisation before the age of 80 were identified. A total of 8966 patients (25.3% women) were interviewed and underwent clinical and biochemical tests at least 6 months after hospital admission. Trends in cardiovascular risk management were assessed on the basis of the 1994-1995, 1999-2000 and 2006-2007 EUROASPIRE surveys. Female survey participants were generally older and had a lower educational level than male participants (pevent. This gap did not appear to narrow between 1994 and 2007.

  11. Coronary Collateral Growth—Back to the Future

    Science.gov (United States)

    Chilian, William M.; Penn, Marc S.; Pung, Yuh Fen; Dong, Feng; Mayorga, Maritza; Ohanyan, Vahagn; Logan, Suzanna; Yin, Liya

    2012-01-01

    The coronary collateral circulation is critically important as an adaptation of the heart to prevent the damage from ischemic insults. In their native state, collaterals in the heart would be classified as part of the microcirculation, existing as arterial-arterial anastomotic connections in the range of 30 to 100 μM in diameter. However, these vessels also show a propensity to remodel into components of the macrocirculation and can become arteries larger than a 1000 μM in diameter. This process of outward remodelling is critically important in the adaptation of the heart to ischemia because the resistance to blood flow is inversely related to the fourth power of the diameter of the vessel. Thus, an expansion of a vessel from 100 to 1000 μM would reduce resistance (in this part of the circuit) to a negligible amount and enable delivery of flow to the region at risk. Our goal in this review is to highlight the voids in understanding this adaptation to ischemia—the growth of the coronary collateral circulation. In doing so we discuss the controversies and unknown aspects of the causal factors that stimulate growth of the collateral circulation, the role of genetics, and the role of endogenous stem and progenitor cells in the context of the normal, physiological situation and under more pathological conditions of ischemic heart disease or with some of the underlying risk factors, e.g., diabetes. The major conclusion of this review is that there are many gaps in our knowledge of coronary collateral growth and this knowledge is critical before the potential of stimulating collateralization in the hearts of patients can be realized. PMID:22210280

  12. Coronary Collateral Growth—Back to the Future

    OpenAIRE

    Chilian, William M.; Penn, Marc S.; Pung, Yuh Fen; Dong, Feng; Mayorga, Maritza; Ohanyan, Vahagn; Logan, Suzanna; Yin, Liya

    2011-01-01

    The coronary collateral circulation is critically important as an adaptation of the heart to prevent the damage from ischemic insults. In their native state, collaterals in the heart would be classified as part of the microcirculation, existing as arterial-arterial anastomotic connections in the range of 30 to 100 μM in diameter. However, these vessels also show a propensity to remodel into components of the macrocirculation and can become arteries larger than a 1000 μM in diameter. This proc...

  13. Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall).

    Science.gov (United States)

    Lehmann, Nils; Erbel, Raimund; Mahabadi, Amir A; Rauwolf, Michael; Möhlenkamp, Stefan; Moebus, Susanne; Kälsch, Hagen; Budde, Thomas; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl-Heinz

    2018-02-13

    Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events. In 3281 participants (45-74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed. We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1-Q3, 23-360] versus 8 [0-83], P value of baseline CT and risk assessment in terms of C-statistic or integrated discrimination index, especially for total cardiovascular events. However, CAC progression did not improve models including CAC 5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CAC b =CAC 5y =0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CAC b progressed from 1 to 399 to CAC 5y ≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC 5y =400. Participants with CAC b ≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively). CAC progression is associated with

  14. Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Denollet, Johan; Pedersen, Susanne S.; Vrints, Christiaan J

    2014-01-01

    Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition...

  15. Recent results and future prospects of dynamic intravenous coronary angiography using synchrotron radiation

    International Nuclear Information System (INIS)

    Ohtsuka, Sadanori

    1999-01-01

    We have developed a dynamic intravenous coronary angiography (IVCAG) by using synchrotron radiation (SR) as a less invasive and more easy examination in place of CAG. Twelve patients suspected to have angina pectoris underwent IVCAG at the clinic in the National Laboratory for High Energy Accelerator Research Organization (KEK). The patients received an intravenous injection of 40m/of contrast agent, and then irradiation was performed with a wide (130 mm x 80 mm) and monochromatic (35 KeV) X-ray beam. Images were acquired with an image intensifier and recorded with a digital fluorography system as dynamic angiography at 30 or 10 images/sec. IVCAG was repeated in 2 or 3 projections. In all patients, the dynamic images permitted clear visualization of the coronary arteries and enabled evaluation of coronary anatomy. Two patients were diagnosed to have coronary stenosis by IVCAG and were confirmed by conventional CAG. The total irradiation doses used for IVCAG were less than those for conventional angiography. Although the image definition obtained with dynamic IVCAG was somewhat less than that of conventional CAG and needs to be improved, the IVCAG can be easily used for the evaluation of coronary arteries and may be clinically used for screening and follow-up of coronary artery disease. In future, the improvement of imaging system, such as increased intensity of synchrotron radiation and high sensitivity in imaging detector, will make more advance in image quality. (author)

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

    Science.gov (United States)

    Koh, Angela S; Murthy, Venkatesh L; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Wu, Justina; Di Carli, Marcelo F; Dorbala, Sharmila

    2015-09-01

    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 (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.

  17. Elevated Serum Neopterin is Associated with Increased Risk of Cardiovascular Events in Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Anwar Santoso

    2009-04-01

    Full Text Available BACKGROUND: Neopterin is a soluble biomarker of monocyte activation and its increased concentration might be expressed in atherosclerosis. Until recently, there has been lacking of information on the prognostic role of neopterin in acute coronary syndromes (ACS. The study was aimed at measuring the associations between elevated serum neopterin and increased risk of cardiovascular (CV events in ACS. METHODS: This was a prospective cohort study, recruited 71 ACS patients from January 31 through August 31, 2007 in Sanglah Hospital of Udayana School of Medicine, Denpasar, Bali. Cardiovascular events, such as: CV death, recurrent myocardial infarction, stroke and recurrent myocardial ischemia were previously defined. Relative risk and survival rate were measured successively by Cox proportional model and Kaplan-Meier curve. RESULTS: Of 71 ACS patients aged 56.8±9.5 years, 21 (29.5% subjects underwent CV events. Overall mean followup was 151.6 (95% CI: 129.7-173.5 days. Baseline characteristic were similarly distributed between groups with the highest quartile neopterin level (≥14.7 nmol/L than those with lowest quartile (≤6.2 nmol/L. Patients with the highest quartile had the worst survival curve than those with the lowest quartile (log-rank test; p=0.047. On Cox proportional model, relative risk of highest quartile group was 5.84 (95% CI: 1.19-28.47; p=0.029 compared to lowest quartile, after being adjusted with other predictors. CONCLUSIONS: Elevated serum neopterin is associated with increased risk of CV events in acute coronary syndromes. KEYWORDS: neopterin, cardiovascular events, acute coronary syndromes.

  18. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Directory of Open Access Journals (Sweden)

    Na Zhao

    Full Text Available Global Registry of Acute Coronary Events (GRACE risk score and red blood cell distribution width (RDW content can both independently predict major adverse cardiac events (MACEs in patients with acute coronary syndrome (ACS. We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58% patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40. GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p < 0.001; 1.699; 1.294-2.232; p < 0.001; respectively. Furthermore, Kaplan-Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001. For GRACE score alone, the area under the receiver operating characteristic (ROC curve for MACEs was 0.749 (95% CI: 0.707-0.787. The area under the ROC curve for MACEs increased to 0.805 (0.766-0.839, p = 0.034 after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001 and integrated discrimination improvement (IDI = 0.023, p = 0.002. Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

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

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    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.

  20. Prognostic implications of nonobstructive coronary plaques in patients with non-ST-segment elevation myocardial infarction: a multidetector computed tomography study

    DEFF Research Database (Denmark)

    Kristensen, Thomas S; Kofoed, Klaus F; Kühl, Jørgen T

    2011-01-01

    We sought to determine whether the amount of noncalcified plaque (NCP) in nonobstructive coronary lesions as detected by multidetector computed tomography (MDCT) was a predictor of future coronary events.......We sought to determine whether the amount of noncalcified plaque (NCP) in nonobstructive coronary lesions as detected by multidetector computed tomography (MDCT) was a predictor of future coronary events....

  1. Noninvasive imaging of coronary arteries: current and future role of multidetector row computer tomography

    International Nuclear Information System (INIS)

    Nedevska, M.; Stoinova, V.

    2006-01-01

    Full text: This review will present the current and future role of cardiac computer tomography (CCT), and particular multidetector CCT, for imaging of atherosclerotic pathologic changes of the coronary arteries. Atherosclerosis and its cardio-vascular complications represent one of the major issues of public health in industrial countries. Different imaging modalities, including invasive coronarography, have been aimed to the diagnosis of the disease, when it provokes symptomatic decrease of the blood flow. In spite of development of surgical and percutaneous methods for coronary revascularization, coronary artery disease remains the major cause of death in North America and Europe. This demonstrates the need of novel, complementary diagnostic strategies, aimed to identify asymptomatic stages as the basis of pharmacological interventions. Noninvasive coronary angiography with multidetector CT allows both assessment of luminal stenosis and subclinical disease of arterial wall. Large trails are missing now to understand and present what will be the role of this technology in the comprehensive assessment of patients, suspected of having CAD. Based on experience and current potentials we will describe how tomographic coronary imaging may eventually supplement traditional angiographic techniques in understanding the patterns of atherosclerotic CAD development

  2. Future Extreme Event Vulnerability in the Rural Northeastern United States

    Science.gov (United States)

    Winter, J.; Bowen, F. L.; Partridge, T.; Chipman, J. W.

    2017-12-01

    Future climate change impacts on humans will be determined by the convergence of evolving physical climate and socioeconomic systems. Of particular concern is the intersection of extreme events and vulnerable populations. Rural areas of the Northeastern United States have experienced increased temperature and precipitation extremes, especially over the past three decades, and face unique challenges due to their physical isolation, natural resources dependent economies, and high poverty rates. To explore the impacts of future extreme events on vulnerable, rural populations in the Northeast, we project extreme events and vulnerability indicators to identify where changes in extreme events and vulnerable populations coincide. Specifically, we analyze future (2046-2075) maximum annual daily temperature, minimum annual daily temperature, maximum annual daily precipitation, and maximum consecutive dry day length for Representative Concentration Pathways (RCP) 4.5 and 8.5 using four global climate models (GCM) and a gridded observational dataset. We then overlay those projections with estimates of county-level population and relative income for 2060 to calculate changes in person-events from historical (1976-2005), with a focus on Northeast counties that have less than 250,000 people and are in the bottom income quartile. We find that across the rural Northeast for RCP4.5, heat person-events per year increase tenfold, far exceeding decreases in cold person-events and relatively small changes in precipitation and drought person-events. Counties in the bottom income quartile have historically (1976-2005) experienced a disproportionate number of heat events, and counties in the bottom two income quartiles are projected to experience a greater heat event increase by 2046-2075 than counties in the top two income quartiles. We further explore the relative contributions of event frequency, population, and income changes to the total and geographic distribution of climate change

  3. Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure.

    Science.gov (United States)

    Pitts, Reynaria; Gunzburger, Elise; Ballantyne, Christie M; Barter, Philip J; Kallend, David; Leiter, Lawrence A; Leitersdorf, Eran; Nicholls, Stephen J; Shah, Prediman K; Tardif, Jean-Claude; Olsson, Anders G; McMurray, John J V; Kittelson, John; Schwartz, Gregory G

    2017-01-10

    Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk. To address this question, we examined data from the dal-OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow-up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78-1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96-1.99, P=0.08) in Cox regression models adjusted for covariates. In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  4. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE).

    Science.gov (United States)

    Furman, Mark I; Gore, Joel M; Anderson, Fredrick A; Budaj, Andrzej; Goodman, Shaun G; Avezum, Avaro; López-Sendón, José; Klein, Werner; Mukherjee, Debabrata; Eagle, Kim A; Dabbous, Omar H; Goldberg, Robert J

    2004-01-01

    To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE). Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear. We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables. Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1-3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2-3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1-4.7; OR for heart failure 2.4, 95% CI 1.8-3.3), non-ST-segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2-3.0; OR for heart failure 1.7, 95% CI 1.1-2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4-5.5; OR for heart failure 2.0, 95% CI 0.9-4.4). In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.

  5. Developing future precipitation events from historic events: An Amsterdam case study.

    Science.gov (United States)

    Manola, Iris; van den Hurk, Bart; de Moel, Hans; Aerts, Jeroen

    2016-04-01

    Due to climate change, the frequency and intensity of extreme precipitation events is expected to increase. It is therefore of high importance to develop climate change scenarios tailored towards the local and regional needs of policy makers in order to develop efficient adaptation strategies to reduce the risks from extreme weather events. Current approaches to tailor climate scenarios are often not well adopted in hazard management, since average changes in climate are not a main concern to policy makers, and tailoring climate scenarios to simulate future extremes can be complex. Therefore, a new concept has been introduced recently that uses known historic extreme events as a basis, and modifies the observed data for these events so that the outcome shows how the same event would occur in a warmer climate. This concept is introduced as 'Future Weather', and appeals to the experience of stakeholders and users. This research presents a novel method of projecting a future extreme precipitation event, based on a historic event. The selected precipitation event took place over the broader area of Amsterdam, the Netherlands in the summer of 2014, which resulted in blocked highways, disruption of air transportation, flooded buildings and public facilities. An analysis of rain monitoring stations showed that an event of such intensity has a 5 to 15 years return period. The method of projecting a future event follows a non-linear delta transformation that is applied directly on the observed event assuming a warmer climate to produce an "up-scaled" future precipitation event. The delta transformation is based on the observed behaviour of the precipitation intensity as a function of the dew point temperature during summers. The outcome is then compared to a benchmark method using the HARMONIE numerical weather prediction model, where the boundary conditions of the event from the Ensemble Prediction System of ECMWF (ENS) are perturbed to indicate a warmer climate. The two

  6. Coronary heart disease events in Aboriginal Australians: incidence in an urban population.

    Science.gov (United States)

    Bradshaw, Pamela J; Alfonso, Helman S; Finn, Judith C; Owen, Julie; Thompson, Peter L

    2009-05-18

    To determine the incidence of coronary heart disease (CHD) events in an urban Aboriginal population. Cohort study of 906 Aboriginal people without CHD from 998 who had undergone risk-factor assessment in the Perth Aboriginal Atherosclerosis Risk Study (PAARS) in 1998-1999. PAARS cohort data were electronically linked to a range of databases that included Western Australian hospital morbidity data and death registry data. We analysed data from January 1980 to December 2006 to identify previous admissions for CHD from 1980 to baseline (1998-1999) and new events from baseline to 2006. First CHD event (hospital admission or death). There were 891 linked records for the 906 participants without previous CHD. The event rate was 12.6/1000 person-years (95% CI, 10.2-15.6/1000 person-years). Annual CHD event rates ranged from 8 to 18/1000 person-years. After adjustment for age (sex was not associated with the risk factors assessed), factors associated with risk of a CHD event in the PAARS cohort were a history of diabetes, overweight or obesity (indicated by body mass index), smoking, and hypertension, but not waist circumference. People with these risk factors were 1.9-2.7 times more likely to experience a CHD event. Compared with previously published information from a remote Aboriginal community in the Northern Territory, the incidence of CHD events among urban-dwelling Aboriginal people was not significantly different (P > 0.05 overall and for subgroups defined by age and sex). City-dwelling Aboriginal Australians have an incidence of CHD events comparable to that of Aboriginal people living in remote northern Australia.

  7. Usefulness of Beta2-Microglobulin as a Predictor of All-Cause and Nonculprit Lesion-Related Cardiovascular Events in Acute Coronary Syndromes (from the PROSPECT Study).

    Science.gov (United States)

    Möckel, Martin; Muller, Reinhold; Searle, Julia; Slagman, Anna; De Bruyne, Bernard; Serruys, Patrick; Weisz, Giora; Xu, Ke; Holert, Fabian; Müller, Christian; Maehara, Akiko; Stone, Gregg W

    2015-10-01

    In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE; C-peptide 1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Not my future? Core values and the neural representation of future events.

    Science.gov (United States)

    Brosch, Tobias; Stussi, Yoann; Desrichard, Olivier; Sander, David

    2018-06-01

    Individuals with pronounced self-transcendence values have been shown to put greater weight on the long-term consequences of their actions when making decisions. Using functional magnetic resonance imaging, we investigated the neural mechanisms underlying the evaluation of events occurring several decades in the future as well as the role of core values in these processes. Thirty-six participants viewed a series of events, consisting of potential consequences of climate change, which could occur in the near future (around 2030), and thus would be experienced by the participants themselves, or in the far future (around 2080). We observed increased activation in anterior VMPFC (BA11), a region involved in encoding the personal significance of future events, when participants were envisioning far future events, demonstrating for the first time that the role of the VMPFC in future projection extends to the time scale of decades. Importantly, this activation increase was observed only in participants with pronounced self-transcendence values measured by self-report questionnaire, as shown by a statistically significant interaction of temporal distance and value structure. These findings suggest that future projection mechanisms are modulated by self-transcendence values to allow for a more extensive simulation of far future events. Consistent with this, these participants reported similar concern ratings for near and far future events, whereas participants with pronounced self-enhancement values were more concerned about near future events. Our findings provide a neural substrate for the tendency of individuals with pronounced self-transcendence values to consider the long-term consequences of their actions.

  9. Self-Predictions and Depressive Realism in Future Life Events.

    Science.gov (United States)

    Walter, Todd J.; And Others

    Research has demonstrated that depressed people lack the optimistic bias evidenced by nondepressed persons and that the former may be more realistic in predicting the outcome of future events (depressive realism hypothesis). This study assesses the depressive realism hypothesis by comparing the accuracy of depressed and nondepressed people's…

  10. High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus: results from the Swedish coronary angiography and angioplasty registry.

    Science.gov (United States)

    Ritsinger, Viveca; Saleh, Nawsad; Lagerqvist, Bo; Norhammar, Anna

    2015-06-01

    Patients with diabetes mellitus have reduced longevity after acute coronary syndromes and revascularization. However, knowledge of the long-term complication rates and patterns from an everyday life setting is lacking. Consecutive patients undergoing percutaneous coronary intervention included in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006 and 2010 and with no previous revascularization were prospectively followed up for combined cardiovascular events (first of all-cause mortality, myocardial infarction, stroke, and heart failure) until December 31, 2010. The mean follow-up period was 920 days (SD, 530 days). Differences in background and procedural characteristics were adjusted for in a multivariate Cox regression model. Of 58 891 patients, mean age 67 years, 19% had diabetes mellitus; 27% of them were on diet treatment, 33% on oral glucose lowering, and 40% on insulin treatment. At admission, cardiovascular risk factors, multiple coronary vessel, and left main stem disease were more frequent in patients with diabetes mellitus and their revascularization was less often complete. The adjusted risk for combined cardiovascular events was higher in patients on insulin (hazard ratio [95% confidence interval], 1.63 [1.55-1.72]), on oral treatment (1.23 [1.15-1.31]), and on diet alone (1.21 [1.12-1.29]) compared with patients without diabetes mellitus. Insulin-treated patients ran an increased risk of restenosis (1.54 [1.39-1.71]) and stent thrombosis (1.56 [1.25-1.96]). The prognosis after a first percutaneous coronary intervention is more severe in patients with diabetes mellitus, in particular, in patients treated with insulin, with higher rates of mortality, cardiovascular events, and stent thrombosis over the following 5 years. © 2015 American Heart Association, Inc.

  11. Non-HDL Cholesterol and Triglycerides: Implications for Coronary Atheroma Progression and Clinical Events.

    Science.gov (United States)

    Puri, Rishi; Nissen, Steven E; Shao, Mingyuan; Elshazly, Mohamed B; Kataoka, Yu; Kapadia, Samir R; Tuzcu, E Murat; Nicholls, Stephen J

    2016-11-01

    Non-high-density lipoprotein cholesterol (non-HDLC) levels reflect the full burden of cholesterol transported in atherogenic lipoproteins. Genetic studies suggest a causal association between elevated triglycerides (TGs)-rich lipoproteins and atherosclerosis. We evaluated associations between achieved non-HDLC and TG levels on changes in coronary atheroma volume. Data were analyzed from 9 clinical trials involving 4957 patients with coronary disease undergoing serial intravascular ultrasonography to assess changes in percent atheroma volume (ΔPAV) and were evaluated against on-treatment non-HDLC and TG levels. The effects of lower (0) was associated with achieved TG levels >200 mg/dL, respectively. Lower on-treatment non-HDLC and TG levels associated with significant PAV regression compared with higher non-HDLC and TG levels across all levels of LDLC and C-reactive protein and irrespective of diabetic status (P<0.001 across all comparisons). ΔPAV were more strongly influenced by changes in non-HDLC (β=0.62; P<0.001) compared with changes in LDLC (β=0.51; P<0.001). Kaplan-Meier sensitivity analyses demonstrated significantly greater major adverse cardiovascular event rates in those with higher versus lower non-HDLC and TG levels, with an earlier separation of the non-HDLC compared with the LDLC curve. Achieved non-HDLC levels seem more closely associated with coronary atheroma progression than LDLC. Plaque progression associates with achieved TGs, but only above levels of 200 mg/dL. These observations support a more prominent role for non-HDLC (and possibly TG) lowering in combating residual cardiovascular risk. © 2016 American Heart Association, Inc.

  12. Disentangling the effect of illness perceptions on health status in people with type 2 diabetes after an acute coronary event.

    Science.gov (United States)

    Vos, Rimke Cathelijne; Kasteleyn, Marise Jeannine; Heijmans, Monique Johanna; de Leeuw, Elke; Schellevis, François Georges; Rijken, Mieke; Rutten, Guy Emile

    2018-03-02

    Chronically ill patients such as people with type 2 diabetes develop perceptions of their illness, which will influence their coping behaviour. Perceptions are formed once a health threat has been recognised. Many people with type 2 diabetes suffer from multimorbidity, for example the combination with cardiovascular disease. Perceptions of one illness may influence perceptions of the other condition. The aim of the current study was to evaluate the effect of an intervention in type 2 diabetes patients with a first acute coronary event on change in illness perceptions and whether this mediates the intervention effect on health status. The current study is a secondary data analysis of a RCT. Two hundred one participants were randomised (1:1 ratio) to the intervention (n = 101, three home visits) or control group (n = 100). Outcome variables were diabetes and acute coronary event perceptions, assessed with the two separate Brief Illness Perceptions Questionnaires (BIPQs); and health status (Euroqol Visual Analog Scale (EQ-VAS)). The intervention effect was analysed using ANCOVA. Linear regression analyses were used to assess whether illness perceptions mediated the intervention effect on health status. A positive intervention effect was found on the BIPQ diabetes items coherence and treatment control (F = 8.19, p = 0.005; F = 14.01, p effect was found on the other BIPQ diabetes items consequence, personal control, identity, illness concern and emotional representation. Regarding the acute coronary event, a positive intervention effect on treatment control was found (F = 7.81, p = 0.006). No intervention effect was found on the other items of the acute coronary event BIPQ. Better diabetes coherence was associated with improved health status, whereas perceiving more treatment control was not. The mediating effect of the diabetes perception 'coherence' on health status was not significant. Targeting illness perceptions of people with

  13. Future challenges in single event effects for advanced CMOS technologies

    International Nuclear Information System (INIS)

    Guo Hongxia; Wang Wei; Luo Yinhong; Zhao Wen; Guo Xiaoqiang; Zhang Keying

    2010-01-01

    SEE have became a substantial Achilles heel for the reliability of space-based advanced CMOS technologies with features size downscaling. Future space and defense systems require identification and understanding of single event effects to develop hardening approaches for advanced technologies, including changes in device geometry and materials affect energy deposition, charge collection,circuit upset, parametric degradation devices. Topics covered include the impact of technology scaling on radiation response, including single event transients in high speed digital circuits, evidence for single event effects caused by proton direct ionization, and the impact for SEU induced by particle energy effects and indirect ionization. The single event effects in CMOS replacement technologies are introduced briefly. (authors)

  14. CT coronary angiography: examination technique, clinical results, and outlook on future developments

    International Nuclear Information System (INIS)

    Dewey, M.; Hamm, B.

    2007-01-01

    Multislice computed tomography (MSCT) after intravenous contrast agent administration enables visualization of the coronary arteries with high spatial resolution (voxel sizes down to 0.5 x 0.35 x 0.35 mm3) and a short scan time. Magnetic resonance imaging (MRI) is also intensively studied with respect to the noninvasive detection of coronary artery stenosis and thus the detection of coronary artery disease (CAD) without radiation exposure but is not equal to MSCT at present. This article provides an overview of the historical development of CT coronary angiography from 4-slice CT to 16-slice CT and 64-slice CT. A crucial aspect of this development is the improvement in image quality resulting from shorter breath-hold periods and the reduced gantry rotation time. Other techniques that appear to considerably improve image quality and accuracy and make CT independent of patient heart rates are multisegment reconstruction and dual-source CT. Sublingual nitroglycerin as well as oral or intravenous betablocker administration should be considered in relation to the diagnostic question to be answered and the patient's heart rate. In the studies available CT coronary angiography with at least 12 simultaneous detector rows has a sensitivity of 96.9 % and a specificity of 75.3 % at the patient level. Especially the negative predictive value of CT (94.6 %) emphasizes the idea that this technique may reliably exclude CAD in patients with intermediate pretest likelihood. In the near future, 256-slice CT will allow examination of the entire heart during one heartbeat or even 4D CT scanning with simultaneous assessment of myocardial perfusion. Automatic or semiautomatic software tools will assume a central place in detecting and quantifying coronary artery stenoses and plaques as well as in the analysis of cardiac function in the clinical setting over the next years. Prior to its routine clinical use, the cost-effectiveness of CT coronary angiography must be determined and the

  15. Design and baseline data from the Gratitude Research in Acute Coronary Events (GRACE) study.

    Science.gov (United States)

    Huffman, Jeff C; Beale, Eleanor E; Beach, Scott R; Celano, Christopher M; Belcher, Arianna M; Moore, Shannon V; Suarez, Laura; Gandhi, Parul U; Motiwala, Shweta R; Gaggin, Hanna; Januzzi, James L

    2015-09-01

    Positive psychological constructs, especially optimism, have been linked with superior cardiovascular health. However, there has been minimal study of positive constructs in patients with acute coronary syndrome (ACS), despite the prevalence and importance of this condition. Furthermore, few studies have examined multiple positive psychological constructs and multiple cardiac-related outcomes within the same cohort to determine specifically which positive construct may affect a particular cardiac outcome. The Gratitude Research in Acute Coronary Events (GRACE) study examines the association between optimism/gratitude 2weeks post-ACS and subsequent clinical outcomes. The primary outcome measure is physical activity at 6months, measured via accelerometer, and key secondary outcome measures include levels of prognostic biomarkers and rates of nonelective cardiac rehospitalization at 6months. These relationships will be analyzed using multivariable linear regression, controlling for sociodemographic, medical, and negative psychological factors; associations between baseline positive constructs and subsequent rehospitalizations will be assessed via Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessment; the cohort had a mean age of 61.5+/?10.5years and was 84% men; this was the first ACS for 58% of participants. The GRACE study will determine whether optimism and gratitude are prospectively and independently associated with physical activity and other critical outcomes in the 6months following an ACS. If these constructs are associated with superior outcomes, this may highlight the importance of these constructs as independent prognostic factors post-ACS. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome.

    Science.gov (United States)

    Sigurjonsdottir, R; Barywani, S; Albertsson, P; Fu, M

    2016-11-01

    Although the elderly comprise the majority of acute coronary syndrome (ACS) patients, limited data exist on major adverse cardiovascular events (MACEs) and quality of life (QoL). To study MACEs and QoL prospectively in ACS patients >70years referred for coronary angiography. A prospective observational study that included ACS patients >70years undergoing coronary angiography. The outcomes were MACEs and QoL 3years after inclusion. MACEs were defined as death, recurrent ACS, new-onset of heart failure and repeated revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). A QoL questionnaire was completed by the patients along with a physical examination and a personal interview at the 3-year follow-up. Multivariate analysis was performed to identify the predictors for MACEs. In total, 138 patients (mean age 78.8±3.8years) with ACS were included in the study. Mean follow-up was 1196±296days. In all, 42% of the patients had MACEs and 25% had post-ACS heart failure. The mortality rate was 11%. After adjusting for significant cardiovascular risk factors, the following factors were significantly associated with MACEs: Age, high-sensitive troponin T (hsTNT), use of diuretics and reduced left ventricular ejection fraction (LVEF). Furthermore, the QoL evaluated with SF-36 in survivors from ACS at the end of study was similar to the QoL in an age-matched healthy Swedish population. In this prospective study on elderly ACS patients MACEs still occurred in 42% of the cases (despite low mortality and good QoL), with post-ACS heart failure as the most important event. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  18. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis.

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-10-01

    Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank P = 0.008 and P = 0.0158). In models adjusted for age, race/ethnicity, Multi-ethnic Study Atherosclerosis site, and traditional cardiovascular disease risk factors, this risk for coronary heart disease and stroke remained (hazard ratio, 2.08; 95% CI, 1.17-3.70; and hazard ratio, 2.19; 95% CI, 1.11-4.32, respectively). Early menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors.

  19. Alcoholics' and nonalcoholics' attributions of control of future life events.

    Science.gov (United States)

    Wright, M H; Obitz, F W

    1984-03-01

    Alcoholic and nonalcoholic subjects rated the degree of control that they and others possess over future life events. Alcoholics attributed less personal control over events to themselves than nonalcoholics did. Alcoholics also attributed less control to themselves than to others, whereas nonalcoholics attributed more control to themselves than to others. These differences prevailed despite the similar socioeconomic and demographic characteristics, recent life experiences and beliefs concerning the general controllability of events of both alcoholics and nonalcoholics. The attributions of alcoholics were consistent with others' notions of self-handicapping. The attributions of nonalcoholics were consistent with control motivation. Alcoholics who attributed less control to themselves than to others more frequently failed to complete treatment than did alcoholics who attributed more control to themselves.

  20. Candidate gravitational microlensing events for future direct lens imaging

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, C. B.; Gould, A.; Gaudi, B. S. [Department of Astronomy, The Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Park, H.; Han, C. [Department of Physics, Institute for Astrophysics, Chungbuk National University, Cheongju 371-763 (Korea, Republic of); Sumi, T.; Koshimoto, N. [Department of Earth and Space Science, Osaka University, Osaka 560-0043 (Japan); Udalski, A. [Warsaw University Observatory, Al. Ujazdowskie 4, 00-478 Warszawa (Poland); Tsapras, Y. [Las Cumbres Observatory Global Telescope Network, 6740 Cortona Drive, Suite 102, Goleta, CA 93117 (United States); Bozza, V. [Department of Physics, University of Salerno, I-84084 Fisciano (Italy); Abe, F.; Fukunaga, D.; Itow, Y.; Masuda, K. [Solar-Terrestrial Environment Laboratory, Nagoya University, Nagoya 464-8601 (Japan); Bennett, D. P. [Department of Physics, University of Notre Dame, 225 Nieuwland Science Hall, Notre Dame, IN 46556-5670 (United States); Bond, I. A.; Ling, C. H. [Institute of Information and Mathematical Sciences, Massey University, Private Bag 102-904, North Shore Mail Centre, Auckland 0745 (New Zealand); Botzler, C. S.; Freeman, M. [Department of Physics, University of Auckland, Private Bag 92-019, Auckland 1001 (New Zealand); Fukui, A. [School of Chemical and Physical Sciences, Victoria University, Wellington 6140 (New Zealand); Collaboration: MOA Collaboration; OGLE Collaboration; μFUN Collaboration; RoboNet Collaboration; and others

    2014-10-10

    The mass of the lenses giving rise to Galactic microlensing events can be constrained by measuring the relative lens-source proper motion and lens flux. The flux of the lens can be separated from that of the source, companions to the source, and unrelated nearby stars with high-resolution images taken when the lens and source are spatially resolved. For typical ground-based adaptive optics (AO) or space-based observations, this requires either inordinately long time baselines or high relative proper motions. We provide a list of microlensing events toward the Galactic bulge with high relative lens-source proper motion that are therefore good candidates for constraining the lens mass with future high-resolution imaging. We investigate all events from 2004 to 2013 that display detectable finite-source effects, a feature that allows us to measure the proper motion. In total, we present 20 events with μ ≳ 8 mas yr{sup –1}. Of these, 14 were culled from previous analyses while 6 are new, including OGLE-2004-BLG-368, MOA-2005-BLG-36, OGLE-2012-BLG-0211, OGLE-2012-BLG-0456, MOA-2012-BLG-532, and MOA-2013-BLG-029. In ≲12 yr from the time of each event the lens and source of each event will be sufficiently separated for ground-based telescopes with AO systems or space telescopes to resolve each component and further characterize the lens system. Furthermore, for the most recent events, comparison of the lens flux estimates from images taken immediately to those estimated from images taken when the lens and source are resolved can be used to empirically check the robustness of the single-epoch method currently being used to estimate lens masses for many events.

  1. Candidate gravitational microlensing events for future direct lens imaging

    International Nuclear Information System (INIS)

    Henderson, C. B.; Gould, A.; Gaudi, B. S.; Park, H.; Han, C.; Sumi, T.; Koshimoto, N.; Udalski, A.; Tsapras, Y.; Bozza, V.; Abe, F.; Fukunaga, D.; Itow, Y.; Masuda, K.; Bennett, D. P.; Bond, I. A.; Ling, C. H.; Botzler, C. S.; Freeman, M.; Fukui, A.

    2014-01-01

    The mass of the lenses giving rise to Galactic microlensing events can be constrained by measuring the relative lens-source proper motion and lens flux. The flux of the lens can be separated from that of the source, companions to the source, and unrelated nearby stars with high-resolution images taken when the lens and source are spatially resolved. For typical ground-based adaptive optics (AO) or space-based observations, this requires either inordinately long time baselines or high relative proper motions. We provide a list of microlensing events toward the Galactic bulge with high relative lens-source proper motion that are therefore good candidates for constraining the lens mass with future high-resolution imaging. We investigate all events from 2004 to 2013 that display detectable finite-source effects, a feature that allows us to measure the proper motion. In total, we present 20 events with μ ≳ 8 mas yr –1 . Of these, 14 were culled from previous analyses while 6 are new, including OGLE-2004-BLG-368, MOA-2005-BLG-36, OGLE-2012-BLG-0211, OGLE-2012-BLG-0456, MOA-2012-BLG-532, and MOA-2013-BLG-029. In ≲12 yr from the time of each event the lens and source of each event will be sufficiently separated for ground-based telescopes with AO systems or space telescopes to resolve each component and further characterize the lens system. Furthermore, for the most recent events, comparison of the lens flux estimates from images taken immediately to those estimated from images taken when the lens and source are resolved can be used to empirically check the robustness of the single-epoch method currently being used to estimate lens masses for many events.

  2. Tailored support for type 2 diabetes patients after an acute coronary event : The Diacourse-ACE study

    NARCIS (Netherlands)

    Kasteleyn, M.J.

    2015-01-01

    Aims: The aims of this thesis were to define the clinical profile and difficulties encountered by type 2 diabetes patients with a first acute coronary event (ACE), to develop and evaluate a tailored supportive intervention for type 2 diabetes patients with a first ACE and to examine diabetes-related

  3. Platelet density per monocyte predicts adverse events in patients after percutaneous coronary intervention.

    Science.gov (United States)

    Rutten, Bert; Roest, Mark; McClellan, Elizabeth A; Sels, Jan W; Stubbs, Andrew; Jukema, J Wouter; Doevendans, Pieter A; Waltenberger, Johannes; van Zonneveld, Anton-Jan; Pasterkamp, Gerard; De Groot, Philip G; Hoefer, Imo E

    2016-01-01

    Monocyte recruitment to damaged endothelium is enhanced by platelet binding to monocytes and contributes to vascular repair. Therefore, we studied whether the number of platelets per monocyte affects the recurrence of adverse events in patients after percutaneous coronary intervention (PCI). Platelet-monocytes complexes with high and low median fluorescence intensities (MFI) of the platelet marker CD42b were isolated using cell sorting. Microscopic analysis revealed that a high platelet marker MFI on monocytes corresponded with a high platelet density per monocyte while a low platelet marker MFI corresponded with a low platelet density per monocyte (3.4 ± 0.7 vs 1.4 ± 0.1 platelets per monocyte, P=0.01). Using real-time video microscopy, we observed increased recruitment of high platelet density monocytes to endothelial cells as compared with low platelet density monocytes (P=0.01). Next, we classified PCI scheduled patients (N=263) into groups with high, medium and low platelet densities per monocyte and assessed the recurrence of adverse events. After multivariate adjustment for potential confounders, we observed a 2.5-fold reduction in the recurrence of adverse events in patients with a high platelet density per monocyte as compared with a low platelet density per monocyte [hazard ratio=0.4 (95% confidence interval, 0.2-0.8), P=0.01]. We show that a high platelet density per monocyte increases monocyte recruitment to endothelial cells and predicts a reduction in the recurrence of adverse events in patients after PCI. These findings may imply that a high platelet density per monocyte protects against recurrence of adverse events.

  4. Clinical events in coronary patients who report low distress: adverse effect of repressive coping.

    Science.gov (United States)

    Denollet, Johan; Martens, Elisabeth J; Nyklícek, Ivan; Conraads, Viviane M; de Gelder, Beatrice

    2008-05-01

    Coronary artery disease (CAD) patients who report low distress are considered to be at low psychological risk for clinical events. However, patients with a repressive coping style may fail to detect and report signals of emotional distress. The authors hypothesized that repressive CAD patients are at risk for clinical events, despite low self-rated distress. This was a prospective 5- to 10-year follow-up study, with a mean follow-up of 6.6 years. At baseline, 731 CAD patients filled out Trait-Anxiety (distress), Marlowe-Crowne (defensiveness), and Type D scales; 159 patients were classified as "repressive," 360 as "nonrepressive," and 212 as "Type D." The primary endpoint was a composite of total mortality or myocardial infarction (MI); the secondary endpoint was cardiac mortality/MI. No patients were lost to follow-up; 91 patients had a clinical event (including 35 cardiac death and 32 MI). Repressive patients reported low levels of anxiety, anger and depression at baseline, but were at increased risk for death/MI (21/159 = 13%) compared with nonrepressive patients (22/360 = 6%), p = .009. Poor systolic function, poor exercise tolerance, 3-vessel disease, index MI and Type-D personality--but not depression, anxiety or anger--also independently predicted clinical events. After controlling for these variables, repressive patients still had a twofold increased risk of death/MI, OR = 2.17, 95% CI = 1.10-4.08, p = .025). These findings were replicated for cardiac mortality/MI. CAD patients who use a repressive coping style are at increased risk for clinical events, despite their claims of low emotional distress. This phenomenon may cause an underestimation of the effect of stress on the heart. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

  5. Analysis on Outcome of 3537 Patients with Coronary Artery Disease: Integrative Medicine for Cardiovascular Events

    Directory of Open Access Journals (Sweden)

    Zhu-ye Gao

    2013-01-01

    Full Text Available Aims. To investigate the treatment of hospitalized patients with coronary artery disease (CAD and the prognostic factors in Beijing, China. Materials and Methods. A multicenter prospective study was conducted through an integrative platform of clinical and research at 12 hospitals in Beijing, China. The clinical information of 3537 hospitalized patients with CAD was collected from September 2009 to May 2011, and the efficacy of secondary prevention during one-year followup was evaluated. In addition, a logistic regression analysis was performed to identify some factors which will have independent impact on the prognosis. Results. The average age of all patients was 64.88 ± 11.97. Of them, 65.42% are males. The medicines for patients were as follows: antiplatelet drugs accounting for 91.97%, statins accounting for 83.66%, β-receptor blockers accounting for 72.55%, ACEI/ARB accounting for 58.92%, and revascularization (including PCI and CABG accounting for 40.29%. The overall incidence of cardiovascular events was 13.26% (469/3537. The logistic stepwise regression analysis showed that heart failure (OR, 3.707, 95% CI = 2.756–4.986, age ≥ 65 years old (OR, 2.007, 95% CI = 1.587–2.53, and myocardial infarction (OR, 1.649, 95% CI = 1.322–2.057 were the independent risk factors of others factors for cardiovascular events that occurred during followup of one-year period. Integrative medicine (IM therapy showed the beneficial tendency for decreasing incidence of cardiovascular events, although no statistical significance was found (OR, 0.797, 95% CI = 0.613~1.036. Conclusions. Heart failure, age ≥ 65 years old, and myocardial infarction were associated with an increase in incidence of cardiovascular events, and treatment with IM showed a tendency for decreasing incidence of cardiovascular events.

  6. A taurine-supplemented vegan diet may blunt the contribution of neutrophil activation to acute coronary events.

    Science.gov (United States)

    McCarty, Mark F

    2004-01-01

    Neutrophils are activated in the coronary circulation during acute coronary events (unstable angina and myocardial infarction), often prior to the onset of ischemic damage. Moreover, neutrophils infiltrate coronary plaque in these circumstances, and may contribute to the rupture or erosion of this plaque, triggering thrombosis. Activated neutrophils secrete proteolytic enzymes in latent forms which are activated by the hypochlorous acid (HOCl) generated by myeloperoxidase. These phenomena may help to explain why an elevated white cell count has been found to be an independent coronary risk factor. Low-fat vegan diets can decrease circulating leukocytes--neutrophils and monocytes--possibly owing to down-regulation of systemic IGF-I activity. Thus, a relative neutropenia may contribute to the coronary protection afforded by such diets. However, vegetarian diets are devoid of taurine - the physiological antagonist of HOCl--and tissue levels of this nutrient are relatively low in vegetarians. Taurine has anti-atherosclerotic activity in animal models, possibly reflecting a role for macrophage-derived myeloperoxidase in the atherogenic process. Taurine also has platelet-stabilizing and anti-hypertensive effects that presumably could reduce coronary risk. Thus, it is proposed that a taurine-supplemented low-fat vegan diet represents a rational strategy for diminishing the contribution of activated neutrophils to acute coronary events; moreover, such a regimen would work in a number of other complementary ways to promote cardiovascular health. Moderate alcohol consumption, the well-tolerated drug pentoxifylline, and 5-lipoxygenase inhibitors--zileuton, boswellic acids, fish oil--may also have potential in this regard. Copyright 2004 Elsevier Ltd.

  7. The effect of solar-geomagnetic activity during hospital admission on coronary events within 1 year in patients with acute coronary syndromes

    Science.gov (United States)

    Vencloviene, J.; Babarskiene, R.; Milvidaite, I.; Kubilius, R.; Stasionyte, J.

    2013-12-01

    Some evidence indicates the deterioration of the cardiovascular system during space storms. It is plausible that the space weather conditions during and after hospital admission may affect the risk of coronary events in patients with acute coronary syndromes (ACS). We analyzed the data of 1400 ACS patients who were admitted to the Hospital Lithuanian University of Health Sciences, and who survived for more than 4 days. We evaluated the associations between geomagnetic storms (GS), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after hospital admission and the risk of cardiovascular death (CAD), non-fatal ACS, and coronary artery bypass grafting (CABG) during a period of 1 year; the evaluation was based on the multivariate logistic model, controlling for clinical data. After adjustment for clinical variables, GS occurring in conjunction with SF 1 day before admission increased the risk of CAD by over 2.5 times. GS 2 days after SPE occurred 1 day after admission increased the risk of CAD and CABG by over 2.8 times. The risk of CABG increased by over 2 times in patients admitted during the day of GS and 1 day after SPE. The risk of ACS was by over 1.63 times higher for patients admitted 1 day before or after solar flares.

  8. Assessment of myocardial infarction with delayed-enhancement MRI in coronary artery disease: a correlative study with cardiac events

    International Nuclear Information System (INIS)

    Zhao Xinxiang; Yang Chao; Yang Dakuan; Yuan Shuguang; Yang Xinhuan; Wang Zhong

    2011-01-01

    Objective: To investigate the correlation between recent cardiac events and the score of myocardial infarction by delayed-enhancement MRI (DE-MRI). Methods: DE-MRI was performed in 40 subjects with coronary artery disease. The score of myocardial infarction by DE-MRI, the ejection fraction (EF) by echocardiography, recent cardiac events (the number of weekly nitroglycerin, the number of weekly angina episodes and the onset number of heart failure in the last year), 6-minute walking distance, as well as the Seattle angina questionnaire (SAQ) score were assessed. The Spearman correlation test and Kruskal-Wallis test, Mann-Whitney test were used for the statistics. Results: There were negative correlation between the myocardial infarction score by DE-MRI (median 12, inter-quartile range: 6.0-19.8) and the 6-minute walking distance (378.93±100.53), SAQ score (74.55±11.40) (r was 0.66 and 0.54, P< 0.05). The myocardial infarction score by DE-MRI was strongly correlated with the number of weekly nitroglycerin (median 1; inter-quartile range: 0-2.8), the number of weekly angina episodes (median 3, inter-quartile range: 1-6.5) and the onset number of heart failure in the last year (median 0, inter-quartile range: 0-2) (r was 0.87, 0.85 and 0.89, P<0.05). EF [(49.2±13.72)%] was negative correlation with the number of weekly nitroglycerin, the number of weekly angina episodes and the onset number of heart failure in the last year (r were 0.67, 0.73 and 0.73, P<0.05). Conclusion: DE-MRI can be used for evaluation and prediction of future cardiac events. (authors)

  9. Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

    Directory of Open Access Journals (Sweden)

    John Hughes

    Full Text Available Despite rapid declines over the last two decades, coronary heart disease (CHD mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI, Republic of Ireland (RoI and Scotland.CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i smoking prevalence and (ii physical inactivity rates of up to 15% by 2030; relative decreases in (iii dietary salt intake of up to 30% by 2030 and (iv dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84. In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses.Feasible reductions in four cardiovascular risk factors (already achieved elsewhere could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

  10. Possible future changes in extreme events over Northern Eurasia

    Science.gov (United States)

    Monier, Erwan; Sokolov, Andrei; Scott, Jeffery

    2013-04-01

    In this study, we investigate possible future climate change over Northern Eurasia and its impact on extreme events. Northern Eurasia is a major player in the global carbon budget because of boreal forests and peatlands. Circumpolar boreal forests alone contain more than five times the amount of carbon of temperate forests and almost double the amount of carbon of the world's tropical forests. Furthermore, severe permafrost degradation associated with climate change could result in peatlands releasing large amounts of carbon dioxide and methane. Meanwhile, changes in the frequency and magnitude of extreme events, such as extreme precipitation, heat waves or frost days are likely to have substantial impacts on Northern Eurasia ecosystems. For this reason, it is very important to quantify the possible climate change over Northern Eurasia under different emissions scenarios, while accounting for the uncertainty in the climate response and changes in extreme events. For several decades, the Massachusetts Institute of Technology (MIT) Joint Program on the Science and Policy of Global Change has been investigating uncertainty in climate change using the MIT Integrated Global System Model (IGSM) framework, an integrated assessment model that couples an earth system model of intermediate complexity (with a 2D zonal-mean atmosphere) to a human activity model. In this study, regional change is investigated using the MIT IGSM-CAM framework that links the IGSM to the National Center for Atmospheric Research (NCAR) Community Atmosphere Model (CAM). New modules were developed and implemented in CAM to allow climate parameters to be changed to match those of the IGSM. The simulations presented in this paper were carried out for two emission scenarios, a "business as usual" scenario and a 660 ppm of CO2-equivalent stabilization, which are similar to, respectively, the Representative Concentration Pathways RCP8.5 and RCP4.5 scenarios. Values of climate sensitivity and net aerosol

  11. Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Salzwedel A

    2017-02-01

    Full Text Available Annett Salzwedel,1 Maria-Dorothea Heidler,1,2 Kathrin Haubold,1 Martin Schikora,2 Rona Reibis,3 Karl Wegscheider,4 Michael Jöbges,2 Heinz Völler1,5 1Center for Rehabilitation Research, University of Potsdam, Potsdam, 2Brandenburg Klinik, Bernau, 3Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, 4Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, 5Klinik am See, Rüdersdorf, Germany Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR programs. Although the association between cardiovascular diseases and cognitive impairments (CIs is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men with coronary artery disease following an acute coronary event (ACE were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26 was determined in 182 patients (36.7%. Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046, heavy (physically demanding workloads (26.4 vs 17.8%, P < 0.001, sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026, reduced exercise capacity (102.5 vs 118.8 W, P = 0.006, and a shorter 6-min walking distance

  12. Fibrinogen concentration and risk of ischemic stroke and acute coronary events in 5113 patients with transient ischemic attack and minor ischemic stroke

    NARCIS (Netherlands)

    Rothwell, PM; Howard, SC; Power, DA; Gutnikov, SA; Algra, A; van Gijn, J; Clark, TG; Murphy, MFG; Warlow, CP

    2004-01-01

    Background and Purpose - Fibrinogen is an independent risk factor for coronary events in population-based studies and in patients with coronary heart disease, but there is uncertainty about prediction of stroke, particularly in secondary prevention. Methods - We studied unpublished data from 3

  13. Schema Driven Construction of Future Autobiographical Traumatic Events: The Future is Much More Troubling than the Past

    Science.gov (United States)

    Rubin, David C.

    2013-01-01

    Research on future episodic thought has produced compelling theories and results in cognitive psychology, cognitive neuroscience, and clinical psychology. To integrate these using basic concepts and methods from autobiographical memory research, 76 undergraduates remembered past and imagined future positive and negative events that had or would have a major impact on them. Correlations of the online ratings of visual and auditory imagery, emotion, and other measures demonstrated that individuals used the same processes to the same extent to remember past and construct future events. These measures predicted the theoretically important metacognitive judgment of past reliving and future ‘preliving’ in similar ways. Future negative events had much higher scores than past negative events on standardized tests of reactions to traumatic events, scores in the range that would qualify for a diagnosis of posttraumatic stress disorder (PTSD), which was replicated (n = 52) to check for order effects. Consistent with earlier work, future events had less sensory vividness. Thus, the imagined symptoms of future events were unlikely to be caused by sensory vividness. To confirm this, 63 undergraduates produced numerous added details between two constructions of the same negative future events, removing deficits in rated vividness with no increase in the standardized tests of reactions to traumatic events. Neuroticism predicted individuals’ reactions to negative past events but did not predict imagined reactions to future events. This set of novel methods and findings are interpreted in the contexts of the literatures of episodic future thought, autobiographical memory, PTSD, and classic schema theory. PMID:23607632

  14. Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.

    Science.gov (United States)

    Ranasinghe, Isuru; Naoum, Chris; Aliprandi-Costa, Bernadette; Sindone, Andrew P; Steg, P Gabriel; Elliott, John; McGarity, Bruce; Lefkovits, Jeffrey; Brieger, David

    2012-05-01

    The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.

  15. Catechol-o-methyltransferase gene polymorphism modifies the effect of coffee intake on incidence of acute coronary events.

    Directory of Open Access Journals (Sweden)

    Pertti Happonen

    Full Text Available BACKGROUND: The role of coffee intake as a risk factor for coronary heart disease (CHD has been debated for decades. We examined whether the relationship between coffee intake and incidence of CHD events is dependent on the metabolism of circulating catecholamines, as determined by functional polymorphism of the catechol-O-methyltransferase (COMT gene. METHODOLOGY/PRINCIPAL FINDINGS: In a cohort of 773 men who were 42 to 60 years old and free of symptomatic CHD at baseline in 1984-89, 78 participants experienced an acute coronary event during an average follow-up of 13 years. In logistic regression adjusting for age, smoking, family history of CHD, vitamin C deficiency, blood pressure, plasma cholesterol concentration, and diabetes, the odds ratio (90% confidence interval comparing heavy coffee drinkers with the low activity COMT genotype with those with the high activity or heterozygotic genotypes was 3.2 (1.2-8.4. Urinary adrenaline excretion increased with increasing coffee intake, being over two-fold in heavy drinkers compared with nondrinkers (p = 0.008 for trend. CONCLUSIONS/SIGNIFICANCE: Heavy coffee consumption increases the incidence of acute coronary events in men with low but not high COMT activity. Further studies are required to determine to which extent circulating catecholamines mediate the relationship between coffee intake and CHD.

  16. A Comparative Study of Stressful Life Events and Stress Coping Strategies in Coronary Heart Disease Patients and Non-Patients

    Directory of Open Access Journals (Sweden)

    A. Heidari Pahlavian

    2010-10-01

    Full Text Available Introduction & Objective: Etiological researches suggest that biopsychosocial dimensions are responsible for coronary heart disease (CHD. The main goal of the present research was to compare stressful life events and stress coping strategies in coronary heart patients (Acute Myocardial Infarction and non-patients. Materials & Methods: In this cross sectional research 102 patients (all males suffering from acute myocardial infarction and 162 non-patient individuals after matching were studied and compared with regard to psychosocial life events and stress coping strategies through coping response inventory (Moos, 1993 , scaling of life Events (paykel , 1971 and researcher made questionnaire. Results: The result established that myocardial infarction patients experienced more stress than the control group during one year before heart- attack and they used more inadequate stress coping strategies comparing with the control individuals. Conclusion: This study showed that stress and inadequate coping strategies are important variables for the development of coronary heart diseases. (Sci J Hamadan Univ Med Sci 2010;17(3:33-38

  17. The future of gas and major current events

    International Nuclear Information System (INIS)

    Anon.

    2007-01-01

    Natural gas market has been completely open in France since July 1, 2007. Long-time operators like Gaz de France (GdF) and local distribution companies, have adapted to the new constraints mainly by meeting the requirement to separate the infrastructure business from the commercial activities. Newcomers, mostly well-known foreign companies, have joined the traditional operators. Overall, the French market is working well, rules have been implemented and are being adequately enforced. To support these changes, the French gas industry needs a recognised professional association. The French gas association (AFG) fills this role, and promotes the image of gas through various events, congresses and meetings. This paper expresses the AFG's position concerning the future of gas in relation to major current events: AFG estimates that gas should play a full role in the energy spectrum based on its unique properties and wishes that public authorities take into consideration all features of all energy sources in their strategies, in particular CO 2 emissions all along the energy processes. AFG requests public authorities to set up fair, motivative and stable operating rules at least to the medium term. AFG would like the Energy regulating committee (CRE) to set an investment return rate that gives investors a sufficient incentive without penalizing the gas consumer. The AFG requests also that the administrative procedures for investment are simplified, with clarified rules and a fast arbitration for not delaying the opening of infrastructures. (J.S.)

  18. Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.

    Science.gov (United States)

    Berwanger, Otavio; Santucci, Eliana Vieira; de Barros E Silva, Pedro Gabriel Melo; Jesuíno, Isabella de Andrade; Damiani, Lucas Petri; Barbosa, Lilian Mazza; Santos, Renato Hideo Nakagawa; Laranjeira, Ligia Nasi; Egydio, Flávia de Mattos; Borges de Oliveira, Juliana Aparecida; Dall Orto, Frederico Toledo Campo; Beraldo de Andrade, Pedro; Bienert, Igor Ribeiro de Castro; Bosso, Carlos Eduardo; Mangione, José Armando; Polanczyk, Carisi Anne; Sousa, Amanda Guerra de Moraes Rego; Kalil, Renato Abdala Karam; Santos, Luciano de Moura; Sposito, Andrei Carvalho; Rech, Rafael Luiz; Sousa, Antônio Carlos Sobral; Baldissera, Felipe; Nascimento, Bruno Ramos; Giraldez, Roberto Rocha Corrêa Veiga; Cavalcanti, Alexandre Biasi; Pereira, Sabrina Bernardez; Mattos, Luiz Alberto; Armaganijan, Luciana Vidal; Guimarães, Hélio Penna; Sousa, José Eduardo Moraes Rego; Alexander, John Hunter; Granger, Christopher Bull; Lopes, Renato Delascio

    2018-04-03

    The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use

  19. Relationships Between Components of Blood Pressure and Cardiovascular Events in Patients with Stable Coronary Artery Disease and Hypertension.

    Science.gov (United States)

    Vidal-Petiot, Emmanuelle; Greenlaw, Nicola; Ford, Ian; Ferrari, Roberto; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Parkhomenko, Alexander; Bhatt, Deepak L; Steg, P Gabriel

    2018-01-01

    Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40-1.87), 1.00 (ref), 1.07 (95% CI, 0.94-1.21), 1.54 (95% CI, 1.32-1.79), and 2.34 (95% CI, 1.95-2.81) for PPhypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease. URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564. © 2017 American Heart Association, Inc.

  20. Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings.

    Science.gov (United States)

    Weissgerber, Tracey L; Turner, Stephen T; Mosley, Thomas H; Kardia, Sharon L R; Hanis, Craig L; Milic, Natasa M; Garovic, Vesna D

    2016-03-01

    Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan-Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27-2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension. Copyright © 2016 by the American Society of Nephrology.

  1. Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings

    Science.gov (United States)

    Turner, Stephen T.; Mosley, Thomas H.; Kardia, Sharon L.R.; Hanis, Craig L.; Milic, Natasa M.; Garovic, Vesna D.

    2016-01-01

    Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan–Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27–2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension. PMID:26315531

  2. Early Menopause Predicts Future Coronary Heart Disease and Stroke: The Multi-Ethnic Study of Atherosclerosis (MESA)

    Science.gov (United States)

    Wellons, Melissa; Ouyang, Pamela; Schreiner, Pamela J; Herrington, David M; Vaidya, Dhananjay

    2012-01-01

    Objective Cardiovascular disease is the number one killer of women. Identifying women at risk of cardiovascular disease has tremendous public health importance. Early menopause is associated with increased cardiovascular disease events in some predominantly white populations, but not consistently. Our objective was to determine if a self-reported early menopause (menopause at an age menopause (either natural menopause or surgical removal of ovaries at an age menopause. In survival curves, women with early menopause had worse coronary heart disease and stroke-free survival (log rank p=menopause is positively associated with coronary heart disease and stroke in a multiethnic cohort, independent of traditional cardiovascular disease risk factors. PMID:22692332

  3. Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease.

    Science.gov (United States)

    Larsen, Sanne Bøjet; Grove, Erik Lerkevang; Neergaard-Petersen, Søs; Würtz, Morten; Hvas, Anne-Mette; Kristensen, Steen Dalby

    2017-08-05

    Increased platelet aggregation during antiplatelet therapy may predict cardiovascular events in patients with coronary artery disease. The majority of these patients receive aspirin monotherapy. We aimed to investigate whether high platelet-aggregation levels predict cardiovascular events in stable coronary artery disease patients treated with aspirin. We included 900 stable coronary artery disease patients with either previous myocardial infarction, type 2 diabetes mellitus, or both. All patients received single antithrombotic therapy with 75 mg aspirin daily. Platelet aggregation was evaluated 1 hour after aspirin intake using the VerifyNow Aspirin Assay (Accriva Diagnostics) and Multiplate Analyzer (Roche; agonists: arachidonic acid and collagen). Adherence to aspirin was confirmed by serum thromboxane B 2 . The primary end point was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. At 3-year follow-up, 78 primary end points were registered. The primary end point did not occur more frequently in patients with high platelet-aggregation levels (first versus fourth quartile) assessed by VerifyNow (hazard ratio: 0.5 [95% CI, 0.3-1.1], P =0.08) or Multiplate using arachidonic acid (hazard ratio: 1.0 [95% CI, 0.5-2.1], P =0.92) or collagen (hazard ratio: 1.4 [95% CI, 0.7-2.8], P =0.38). Similar results were found for the composite secondary end point (nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and all-cause death) and the single end points. Thromboxane B 2 levels did not predict any end points. Renal insufficiency was the only clinical risk factor predicting the primary and secondary end points. This study is the largest to investigate platelet aggregation in stable coronary artery disease patients receiving aspirin as single antithrombotic therapy. We found that high platelet-aggregation levels did not predict cardiovascular events. © 2017 The Authors. Published on behalf of the American Heart

  4. Relative associations between depression and anxiety on adverse cardiovascular events: does a history of coronary artery disease matter? A prospective observational study

    OpenAIRE

    Pelletier, Roxanne; Bacon, Simon L; Arsenault, Andr?; Dupuis, Jocelyn; Laurin, Catherine; Blais, Lucie; Lavoie, Kim L

    2015-01-01

    Objectives To assess whether depression and anxiety increase the risk of mortality and major adverse cardiovascular events (MACE), among patients with and without coronary artery disease (CAD). Design and setting, and patients DECADE (Depression Effects on Coronary Artery Disease Events) is a prospective observational study of 2390 patients referred at the Montreal Heart Institute. Patients were followed for 8.8?years, between 1998 and 2009. Depression and anxiety were assessed using a psychi...

  5. Recalibration of the Global Registry of Acute Coronary Events risk score in a multiethnic Asian population.

    Science.gov (United States)

    Chan, Mark Y; Shah, Bimal R; Gao, Fei; Sim, Ling Ling; Chua, Terrance; Tan, Huay Cheem; Yeo, Tiong Cheng; Ong, Hean Yee; Foo, David; Goh, Ping Ping; Surrun, Soondal K; Pieper, Karen S; Granger, Christopher B; Koh, Tian Hai; Salim, Agus; Tai, E Shyong

    2011-08-01

    Acute myocardial infarction (AMI) is a leading cause of mortality in Asia. However, quantitative risk scores to predict mortality after AMI were developed without the participation of Asian countries. We evaluated the performance of the Global Registry of Acute Coronary Events (GRACE) in-hospital mortality risk score, directly and after recalibration, in a large Singaporean cohort representing 3 major Asian ethnicities. The GRACE cohort included 11,389 patients, predominantly of European descent, hospitalized for AMI or unstable angina from 2002 to 2003. The Singapore cohort included 10,100 Chinese, 3,005 Malay, and 2,046 Indian patients hospitalized for AMI from 2002 to 2005.Using the original GRACE score, predicted in-hospital mortality was 2.4% (Chinese), 2.0% (Malay), and 1.6% (Indian). However, observed in-hospital mortality was much greater at 9.8% (Chinese), 7.6% (Malay), and 6.4% (Indian). The c statistic for Chinese, Malays, and Indians was 0.86, 0.86, and 0.84, respectively, and the Hosmer-Lemeshow statistic was 250, 56, and 41, respectively. Recalibration of the GRACE score, using the mean-centered constants derived from the Singapore cohort, did not change the c statistic but substantially improved the Hosmer-Lemeshow statistic to 90, 24, and 18, respectively. The recalibrated GRACE score predicted in-hospital mortality as follows: 7.7% (Chinese), 6.0% (Malay), and 5.2% (Indian). In this large cohort of 3 major Asian ethnicities, the original GRACE score, derived from populations outside Asia, underestimated in-hospital mortality after AMI. Recalibration improved risk estimation substantially and may help adapt externally developed risk scores for local practice. Copyright © 2011 Mosby, Inc. All rights reserved.

  6. Left Atrial Volume Index and Prediction of Events in Acute Coronary Syndrome: Solar Registry

    Directory of Open Access Journals (Sweden)

    Jose Alves Secundo Junior

    2014-10-01

    Full Text Available Background: According to some international studies, patients with acute coronary syndrome (ACS and increased left atrial volume index (LAVI have worse long-term prognosis. However, national Brazilian studies confirming this prediction are still lacking. Objective: To evaluate LAVI as a predictor of major cardiovascular events (MCE in patients with ACS during a 365-day follow-up. Methods: Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated within 48 hours after hospital admission. According to LAVI, two groups were categorized: normal LAVI (≤ 32 mL/m2 and increased LAVI (> 32 mL/m2. Both groups were compared regarding clinical and echocardiographic characteristics, in- and out-of-hospital outcomes, and occurrence of ECM in up to 365 days. Results: Increased LAVI was observed in 78 patients (45%, and was associated with older age, higher body mass index, hypertension, history of myocardial infarction and previous angioplasty, and lower creatinine clearance and ejection fraction. During hospitalization, acute pulmonary edema was more frequent in patients with increased LAVI (14.1% vs. 4.3%, p = 0.024. After discharge, the occurrence of combined outcome for MCE was higher (p = 0.001 in the group with increased LAVI (26% as compared to the normal LAVI group (7% [RR (95% CI = 3.46 (1.54-7.73 vs. 0.80 (0.69-0.92]. After Cox regression, increased LAVI increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012. Conclusion: Increased LAVI is an important predictor of MCE in a one-year follow-up.

  7. Case fatality of acute coronary events is improving even among elderly patients; the FINAMI study 1995-2012.

    Science.gov (United States)

    Koukkunen, Heli; Havulinna, Aki S; Lehto, Seppo; Ketonen, Matti; Mustonen, Juha; Airaksinen, Juhani K; Ukkola, Olavi; Kesäniemi, Y Antero; Salomaa, Veikko

    2018-02-01

    To examine trends in incidence and 28-day case fatality of myocardial infarction (MI) in persons aged 75-99 years in four areas of Finland. The Finnish Acute Myocardial Infarction (FINAMI) register is a population-based MI register study, which during 1995-2012 recorded 30561 suspected acute coronary syndromes in persons aged ≥75 years. Of them, 16229 fulfilled the American Heart Association criteria for a definite, probable or possible MI or coronary death. This age-group contributed 56.8% of all MIs of which 62.7% occurred in women. The incidence of MI decreased by -3.3%/year (95% CI -4.2; -2.4) in women aged 75-84 years, and by -1.2%/year (-1.9; -0.5) in women aged 85-99 years, but among men in these age-groups, only a non-significant reduction occurred. The 28-day case fatality of MI was high. In the age-group 75-84 years, it decreased non-significantly by -1.6%/year in men, and significantly by -2.4%/year (-3.9; -0.8) in women. In the age-group 85-99 years, the decrease was more remarkable: -5.1%/year (-7.8; -2.3) and -3.9%/year (-5.5; -2.2), respectively. In Finland, more than half of MIs occur in the age-group 75-99 years, and most of them in women. The incidence of MI decreased significantly in elderly women but non-significantly in elderly men. The 28-day case fatality decreased especially in the age-group 85-99 years. Key Messages In Finland, more than one half of all myocardial infarctions (MIs) occur in the age-group of 75 years or older. Furthermore, 62.7% of MIs among elderly patients occur among women, although 58.0% of the elderly population are women. The incidence of MI decreased significantly in elderly women but not in elderly men. The 28-day case fatality in elderly patients was high but decreased significantly during the study period 1995-2012. This study provides population-based data on treatment strategies and trends in incidence, event rate, mortality and case fatality of MI in elderly individuals. Elderly patients with acute coronary

  8. Referrals in acute coronary events for CARdiac catheterization: The RACE CAR trial.

    Science.gov (United States)

    Kreatsoulas, Catherine; Sloane, Debi; Pogue, Janice; Velianou, James L; Anand, Sonia S

    2010-10-01

    Women with acute coronary syndromes have lower rates of cardiac catheterization (CC) than men. To determine whether sex⁄gender, age, risk level and patient preference influence physician decision making to refer patients for CC. Twelve clinical scenarios controlling for sex⁄gender, age (55 or 75 years of age), Thrombolysis in Myocardial Infarction risk score (low, moderate or high) and patient preference for CC (agreeable or refused⁄no preference expressed) were designed. Scenarios were administered to specialists across Canada using a web-based computerized survey instrument. Questions were standardized using a five-point Likert scale ranging from 1 (very unlikely to benefit from CC) to 5 (very likely to benefit from CC). Outcomes were assessed using a two-tailed mixed linear regression model. Of 237 scenarios, physicians rated men as more likely to benefit from CC than women (mean [± SE] 4.44±0.07 versus 4.25±0.07, P=0.03), adjusted for age, risk and patient preference. Low-risk men were perceived to benefit more than low-risk women (4.20±0.13 versus 3.54±0.14, Pno comment at all (5.0±0.23, 3.67±0.21, 2.95±0.14, respectively, P<0.01). Canadian specialists' decisions to refer patients for CC appear to be influenced by sex⁄gender, age and patient preference in clinical scenarios in which cardiac risk is held constant. Future investigation of possible age and sex⁄gender biases as proxies for risk is warranted.

  9. Long-term Exposure to Particulate Matter Constituents and the Incidence of Coronary Events in 11 European Cohorts

    DEFF Research Database (Denmark)

    Wolf, Kathrin; Stafoggia, Massimo; Cesaroni, Giulia

    2015-01-01

    with incident coronary events. METHODS: Eleven cohorts from Finland, Sweden, Denmark, Germany, and Italy participated in this analysis. 5,157 incident coronary events were identified within 100,166 persons followed on average for 11.5 years. Long-term residential concentrations of PM PM 2.5 μm...... (PM2.5), and a priori selected constituents (copper, iron, nickel, potassium, silicon, sulfur, vanadium, and zinc) were estimated with land-use regression models. We used Cox proportional hazard models adjusted for a common set of confounders to estimate cohort-specific component effects...... with and without including PM mass, and random effects meta-analyses to pool cohort-specific results. RESULTS: A 100 ng/m³ increase in PM10 K and a 50 ng/m³ increase in PM2.5 K were associated with a 6% (hazard ratio and 95% confidence interval: 1.06 [1.01, 1.12]) and 18% (1.18 [1.06, 1.32]) increase in coronary...

  10. Radiofrequency ablation of accessory pathways in patients with the Wolff-Parkinson-White syndrome: long-term risk of mortality and coronary events.

    Science.gov (United States)

    Wongcharoen, Wanwarang; Lin, Yenn-Jiang; Chung, Fa-Po; Chen, Yun-Yu; Chao, Tze-Fan; Chen, Pei-Chun; Chien, Kuo-Liong; Chen, Shih-Ann

    2017-06-10

    The long-term outcomes of radiofrequency catheter ablation (RFCA) in patients with Wolff-Parkinson-White syndrome (WPW) remain unclear. We investigated the impact of RFCA on the long-term risk of coronary events and mortality in WPW patients. We conducted a prospective cohort study utilizing the Taiwan National Health Insurance Research Database. Between 2000 and 2003, WPW patients with no prior coronary artery disease (CAD) history, aged over 18 years, who underwent RFCA were identified. WPW patients without RFCA were matched with propensity-score 1:4 matching for confounding coronary risk factors. The study outcomes were total mortality and coronary events. A total of 1524 matched non-ablated WPW patients (Group 1) and 381 ablated WPW patients (Group 2) were included. After a mean follow-up of 9.6 ± 2.9 and 10.3 ± 1.9 years, respectively, ablation group demonstrated a lower incidence of mortality compared with non-ablation group (17 vs. 26/1000 person-years, P < 0.001; adjusted HR: 0.57, 95% CI: 0.44-0.7). However, ablation group had a higher incidence of coronary events compared with non-ablation group (47 vs. 82/1000 person-years, P < 0.001; adjusted HR: 1.69, 95% CI: 1.4-2.04). The ablation-treated WPW patients had lower risk of total mortality but higher risk of coronary events than non-ablated WPW patients during the long-term follow-up. Coronary artery injury produced by RFCA may account for the increased risk of coronary events. Therefore, the ablation strategies to avoid coronary artery injury should be implemented. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  11. Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention.

    Science.gov (United States)

    Wang, Shao-Li; Wang, Cheng-Long; Wang, Pei-Li; Xu, Hao; Du, Jian-Peng; Zhang, Da-Wu; Gao, Zhu-Ye; Zhang, Lei; Fu, Chang-Geng; Chen, Ke-Ji; Shi, Da-Zhuo

    2016-03-01

    The study was to access the association between resting heart rate (RHR) and one-year risk of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). Patients with ACS after PCI (n = 808) were prospectively followed-up for MACE. RHR was obtained from electrocardiogram. MACE was defined as a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The association between RHR and one-year risk of MACE was assessed using Cox proportional hazards regression model. Compared with patients with RHR >76 bpm, the adjusted hazard ratio (AHR) was 0.51 (95% confidence intervals [CI]: 0.23-1.14; P = 0.100) for patients with RHR 76 bpm were at higher risk of MACE during one-year follow-up compared with patients with RHR 61-76 bpm. An elevated RHR ≥ 61 bpm was associated with increased risk of one-year MACE in ACS patients. © 2015 by the Society for Experimental Biology and Medicine.

  12. The organization of prospective thinking: evidence of event clusters in freely generated future thoughts.

    Science.gov (United States)

    Demblon, Julie; D'Argembeau, Arnaud

    2014-02-01

    Recent research suggests that many imagined future events are not represented in isolation, but instead are embedded in broader event sequences-referred to as event clusters. It remains unclear, however, whether the production of event clusters reflects the underlying organizational structure of prospective thinking or whether it is an artifact of the event-cuing task in which participants are explicitly required to provide chains of associated future events. To address this issue, the present study examined whether the occurrence of event clusters in prospective thought is apparent when people are left to think freely about events that might happen in their personal future. The results showed that the succession of events participants spontaneously produced when envisioning their future frequently included event clusters. This finding provides more compelling evidence that prospective thinking involves higher-order autobiographical knowledge structures that organize imagined events in coherent themes and sequences. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Unrequested information from routine diagnostic chest CT predicts future cardiovascular events

    International Nuclear Information System (INIS)

    Jacobs, Peter C.; Gondrie, Martijn J.; Grobbee, Diederick E.; Graaf, Yolanda van der; Mali, Willem P.; Oen, Ayke L.; Prokop, Mathias

    2011-01-01

    An increase in the number of CT investigations will likely result in a an increase in unrequested information. Clinical relevance of these findings is unknown. This is the first follow-up study to investigate the prognostic relevance of subclinical coronary (CAC) and aortic calcification (TAC) as contained in routine diagnostic chest CT in a clinical care population. The follow-up of 10,410 subjects (>40 years) from a multicentre, clinical care-based cohort of patients included 240 fatal to 275 non-fatal cardiovascular disease (CVD) events (mean follow-up 17.8 months). Patients with a history of CVD were excluded. Coronary (0-12) and aortic calcification (0-8) were semi-quantitatively scored. We used Cox proportional-hazard models to compute hazard ratios to predict CVD events. CAC and TAC were significantly and independently predictive of CVD events. Compared with subjects with no calcium, the adjusted risk of a CVD event was 3.7 times higher (95% CI, 2.7-5.2) among patients with severe coronary calcification (CAC score ≥6) and 2.7 times higher (95% CI, 2.0-3.7) among patients with severe aortic calcification (TAC score ≥5). Subclinical vascular calcification on CT is a strong predictor of incident CVD events in a routine clinical care population. (orig.)

  14. Ankle Brachial Index Compared With Different Lipid Ratios to Predict Coronary Events in Patients with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2014-02-01

    Multivariable adjusted relations revealed that HDL-C and #8804;34 Mg/dl significantly increased the risk of future UA, HDL-C and #8804;53 Mg/dl and sedentary life style increased the risk of MI. CONCLUSION: Multivariate adjusted relationships revealed that HDL-C and #8804;34 Mg/dl was a strong predictor of unstable angina pectoris after 15 months of follow up period. HDL-C and #8804;53 Mg/dl and physical inactivity were associated with increased risk of MI after 15 months. Of the lipid ratios the strongest predictors for developing future MI and unstable angina were TC/HDL-C and LDL-C/HDL-C. [TAF Prev Med Bull 2014; 13(1.000: 29-36

  15. Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus.

    Science.gov (United States)

    Ekmekci, Ahmet; Cicek, Gokhan; Uluganyan, Mahmut; Gungor, Baris; Osman, Faizel; Ozcan, Kazim Serhan; Bozbay, Mehmet; Ertas, Gokhan; Zencirci, Aycan; Sayar, Nurten; Eren, Mehmet

    2014-02-01

    Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose 145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

  16. Plaque Structural Stress Estimations Improve Prediction of Future Major Adverse Cardiovascular Events After Intracoronary Imaging.

    Science.gov (United States)

    Brown, Adam J; Teng, Zhongzhao; Calvert, Patrick A; Rajani, Nikil K; Hennessy, Orla; Nerlekar, Nitesh; Obaid, Daniel R; Costopoulos, Charis; Huang, Yuan; Hoole, Stephen P; Goddard, Martin; West, Nick E J; Gillard, Jonathan H; Bennett, Martin R

    2016-06-01

    Although plaque rupture is responsible for most myocardial infarctions, few high-risk plaques identified by intracoronary imaging actually result in future major adverse cardiovascular events (MACE). Nonimaging markers of individual plaque behavior are therefore required. Rupture occurs when plaque structural stress (PSS) exceeds material strength. We therefore assessed whether PSS could predict future MACE in high-risk nonculprit lesions identified on virtual-histology intravascular ultrasound. Baseline nonculprit lesion features associated with MACE during long-term follow-up (median: 1115 days) were determined in 170 patients undergoing 3-vessel virtual-histology intravascular ultrasound. MACE was associated with plaque burden ≥70% (hazard ratio: 8.6; 95% confidence interval, 2.5-30.6; P<0.001) and minimal luminal area ≤4 mm(2) (hazard ratio: 6.6; 95% confidence interval, 2.1-20.1; P=0.036), although absolute event rates for high-risk lesions remained <10%. PSS derived from virtual-histology intravascular ultrasound was subsequently estimated in nonculprit lesions responsible for MACE (n=22) versus matched control lesions (n=22). PSS showed marked heterogeneity across and between similar lesions but was significantly increased in MACE lesions at high-risk regions, including plaque burden ≥70% (13.9±11.5 versus 10.2±4.7; P<0.001) and thin-cap fibroatheroma (14.0±8.9 versus 11.6±4.5; P=0.02). Furthermore, PSS improved the ability of virtual-histology intravascular ultrasound to predict MACE in plaques with plaque burden ≥70% (adjusted log-rank, P=0.003) and minimal luminal area ≤4 mm(2) (P=0.002). Plaques responsible for MACE had larger superficial calcium inclusions, which acted to increase PSS (P<0.05). Baseline PSS is increased in plaques responsible for MACE and improves the ability of intracoronary imaging to predict events. Biomechanical modeling may complement plaque imaging for risk stratification of coronary nonculprit lesions. © 2016

  17. Using Family Science Day Events to Inspire Future Scientists

    Science.gov (United States)

    Brevik, Corinne

    2015-04-01

    Dickinson State University organizes four Family Science Day events each fall to increase student engagement in the sciences. Offered on Saturday afternoons, each event focuses on a different science-related theme. Families can attend these events free of charge, and the kids participate in a large-variety of hands-on activities which center around the event's theme. Previous themes include The Amazing Telescope, Night of the Titanic, Dinosaur Prophecy, and Space Exploration. These events are amazing opportunities to show young children how much fun science can be. Many of the kids come from schools where science is neither interactive nor engaging. The activities help the children learn that science is a process of discovery that helps us better understand the world around us. University students staff all of the activity booths at these events, and this has proven to be a very valuable experience for them as well. Some of the students who help are majoring in a science field, and for them, the experience teaches public communication. They learn to break complicated concepts down into simpler terms that young kids can understand. Other students who help with these events are not science majors but may be taking a science course as part of their college curriculum. For these students, the experience reinforces various concepts that they are learning in their science class. For many of them, it also opens their eyes to the idea that science can be engaging. Some of them even discover that they have a true gift for teaching.

  18. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to Predict the Occurrence of Short-Term Coronary Heart Disease Events in Women.

    Science.gov (United States)

    McSweeney, Jean C; Cleves, Mario A; Fischer, Ellen P; Pettey, Christina M; Beasley, Brittany

    Few instruments capture symptoms that predict cardiac events in the short-term. This study examines the ability of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey to predict acute cardiac events within 3 months of administration and to identify the prodromal symptoms most associated with short-term risk in women without known coronary heart disease. The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey was administered to 1,097 women referred to a cardiologist for initial coronary heart disease evaluation. Logistic regression models were used to examine prodromal symptoms individually and in combination to identify the subset of symptoms most predictive of an event within 3 months. Fifty-one women had an early cardiac event. In bivariate analyses, 4 of 30 prodromal symptoms were significantly associated with event occurrence within 90 days. In adjusted analyses, women reporting arm pain or discomfort and unusual fatigue were more likely (OR, 4.67; 95% CI, 2.08-10.48) to have a cardiac event than women reporting neither. The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey may assist in predicting short-term coronary heart disease events in women without known coronary heart disease. Copyright © 2017 Jacobs Institute of Women's Health. All rights reserved.

  19. Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, Christopher L. [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Nance, John W. Jr. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); O’Brien, Terrence X. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (United States); Ebersberger, Ullrich [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich (Germany); Headden, Gary F. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bamberg, Fabian [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich (Germany); Department of Radiology, University of Tuebingen (Germany)

    2014-07-15

    Highlights: • Patients developing UAP had overall more atherosclerosis as patients without any events. • Patients developing MACE had only more mixed plaque as those developing UAP. • Different atherosclerotic plaque components by CTA carry different prognostic value. - Abstract: Objective: CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). Methods: We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Results: Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. Conclusion: The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.

  20. Risk of Incident Coronary Heart Disease Events in Men Compared to Women by Menopause Type and Race

    Science.gov (United States)

    Kim, Catherine; Cushman, Mary; Khodneva, Yulia; Lisabeth, Lynda D; Judd, Suzanne; Kleindorfer, Dawn O; Howard, Virginia J; Safford, Monika M

    2015-01-01

    Background We examined whether type of menopause affects sex differences in coronary heart disease (CHD) events and whether the impact is similar in blacks and whites. Methods and Results Participants were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007 without CHD at baseline (n=23 086). Cox regression models were used to calculate the hazard of incident nonfatal CHD (definite or probable myocardial infarction) and acute CHD death, adjusting for age, age at last menstrual period menopause (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.31, 0.66) and surgical menopause (HR, 0.65; 95% CI, 0.42, 0.99) had a reduced hazard of nonfatal events, compared to white men. Black women in natural menopause (HR, 0.69; 95% CI, 0.47, 1.03), but not surgical menopause (HR, 0.81; 95% CI, 0.51, 1.29), had a marginally reduced hazard of nonfatal events, compared to black men. Women had lower risk of acute CHD death than men regardless of their menopause type and race. Conclusions Sex differences in the risk of incident CHD events were larger among whites than blacks and varied by type of menopause. Women consistently had a lower risk of incident CHD death than men, but the magnitude of sex differences was greater in whites than blacks for nonfatal events, regardless of menopause type. PMID:26133958

  1. Association between sucrose intake and acute coronary event risk and effect modification by lifestyle factors: Malmö Diet and Cancer Cohort Study.

    Science.gov (United States)

    Warfa, K; Drake, I; Wallström, P; Engström, G; Sonestedt, E

    2016-11-01

    Previous studies have suggested that a high intake of sugar-sweetened beverages is positively associated with the risk of a coronary event. However, a few studies have examined the association between sucrose (the most common extrinsic sugar in Sweden) and incident coronary events. The objective of the present study was to examine the associations between sucrose intake and coronary event risk and to determine whether these associations are specific to certain subgroups of the population (i.e. according to physical activity, obesity status, educational level, alcohol consumption, smoking habits, intake of fat and intake of fruits and vegetables). We performed a prospective analysis on 26 190 individuals (62 % women) free from diabetes and without a history of CVD from the Swedish population-based Malmö Diet and Cancer cohort. Over an average of 17 years of follow-up (457 131 person-years), 2493 incident cases of coronary events were identified. Sucrose intake was obtained from an interview-based diet history method, including 7-d records of prepared meals and cold beverages and a 168-item diet questionnaire covering other foods. Participants who consumed >15 % of their energy intake (E%) from sucrose showed a 37 (95 % CI 13, 66) % increased risk of a coronary event compared with the lowest sucrose consumers (<5 E%) after adjusting for potential confounders. The association was not modified by the selected lifestyle factors. The results indicated that sucrose consumption higher than 15 E% (5 % of this population) is associated with an increased risk of a coronary event.

  2. RANTES/CCL5 and risk for coronary events: results from the MONICA/KORA Augsburg case-cohort, Athero-Express and CARDIoGRAM studies.

    Directory of Open Access Journals (Sweden)

    Christian Herder

    Full Text Available The chemokine RANTES (regulated on activation, normal T-cell expressed and secreted/CCL5 is involved in the pathogenesis of cardiovascular disease in mice, whereas less is known in humans. We hypothesised that its relevance for atherosclerosis should be reflected by associations between CCL5 gene variants, RANTES serum concentrations and protein levels in atherosclerotic plaques and risk for coronary events.We conducted a case-cohort study within the population-based MONICA/KORA Augsburg studies. Baseline RANTES serum levels were measured in 363 individuals with incident coronary events and 1,908 non-cases (mean follow-up: 10.2±4.8 years. Cox proportional hazard models adjusting for age, sex, body mass index, metabolic factors and lifestyle factors revealed no significant association between RANTES and incident coronary events (HR [95% CI] for increasing RANTES tertiles 1.0, 1.03 [0.75-1.42] and 1.11 [0.81-1.54]. None of six CCL5 single nucleotide polymorphisms and no common haplotype showed significant associations with coronary events. Also in the CARDIoGRAM study (>22,000 cases, >60,000 controls, none of these CCL5 SNPs was significantly associated with coronary artery disease. In the prospective Athero-Express biobank study, RANTES plaque levels were measured in 606 atherosclerotic lesions from patients who underwent carotid endarterectomy. RANTES content in atherosclerotic plaques was positively associated with macrophage infiltration and inversely associated with plaque calcification. However, there was no significant association between RANTES content in plaques and risk for coronary events (mean follow-up 2.8±0.8 years.High RANTES plaque levels were associated with an unstable plaque phenotype. However, the absence of associations between (i RANTES serum levels, (ii CCL5 genotypes and (iii RANTES content in carotid plaques and either coronary artery disease or incident coronary events in our cohorts suggests that RANTES may not be a

  3. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared to clopidogrel: Data from the PLATO trials

    DEFF Research Database (Denmark)

    Patel, Manesh R.; Becker, Richard C.; Wojdyla, Daniel M.

    Abstract 14299: Cardiovascular Events in Acute Coronary Syndrome Patients With Peripheral Arterial Disease Treated With Ticagrelor Compared to Clopidogrel: Data From the PLATO Trial Manesh R Patel1; Richard C Becker1; Daniel M Wojdyla2; Håkan Emanuelsson3; William Hiatt4; Jay Horrow5; Steen Husted6...... Uppsala, Sweden 10 Cardiology, Uppsala Clinical Rsch center, 75185 Uppsala, Sweden Background: Patients with peripheral artery disease (PAD) and acute coronary syndrome (ACS) are at high risk for clinical events and are often difficult to manage. We evaluated cardiovascular outcomes of ACS patients...

  4. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins.

    Science.gov (United States)

    Schwartz, Gregory G; Abt, Markus; Bao, Weihang; DeMicco, David; Kallend, David; Miller, Michael; Mundl, Hardi; Olsson, Anders G

    2015-06-02

    Most patients with acute coronary syndrome (ACS) are treated with statins, which reduce atherogenic triglyceride-rich lipoproteins. It is uncertain whether triglycerides predict risk after ACS on a background of statin treatment. This study examined the relationship of fasting triglyceride levels to outcomes after ACS in patients treated with statins. Long-term and short-term relationships of triglycerides to risk after ACS were examined in the dal-OUTCOMES trial and atorvastatin arm of the MIRACL (Myocardial Ischemia Reduction with Acute Cholesterol Lowering) trial, respectively. Analysis of dal-OUTCOMES included 15,817 patients (97% statin-treated) randomly assigned 4 to 12 weeks after ACS to treatment with dalcetrapib (a cholesteryl ester transfer protein inhibitor) or placebo and followed for a median 31 months. Analysis of MIRACL included 1,501 patients treated with atorvastatin 80 mg daily beginning 1 to 4 days after ACS and followed for 16 weeks. Fasting triglycerides at initial random assignment were related to risk of coronary heart disease death, nonfatal myocardial infarction, stroke, and unstable angina in models adjusted for age, sex, hypertension, smoking, diabetes, high-density lipoprotein cholesterol, and body mass index. Fasting triglyceride levels were associated with both long-term and short-term risk after ACS. In dal-OUTCOMES, long-term risk increased across quintiles of baseline triglycerides (p175/≤80 mg/dl) was 1.61 (95% confidence interval: 1.34 to 1.94). There was no interaction of triglycerides and treatment assignment on the primary outcome. In the atorvastatin group of MIRACL, short-term risk increased across tertiles of baseline triglycerides (p=0.03), with a hazard ratio of 1.50 [corrected] (95% confidence interval: 1.05 to 2.15) in highest/lowest tertiles (>195/≤135 mg/dl). The relationship of triglycerides to risk was independent of low-density lipoprotein cholesterol in both studies. Among patients with ACS treated effectively

  5. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes.

    Science.gov (United States)

    Chow, Clara K; Jolly, Sanjit; Rao-Melacini, Purnima; Fox, Keith A A; Anand, Sonia S; Yusuf, Salim

    2010-02-16

    Although preventive drug therapy is a priority after acute coronary syndrome, less is known about adherence to behavioral recommendations. The aim of this study was to examine the influence of adherence to behavioral recommendations in the short term on risk of cardiovascular events. The study population included 18 809 patients from 41 countries enrolled in the Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5 randomized clinical trial. At the 30-day follow-up, patients reported adherence to diet, physical activity, and smoking cessation. Cardiovascular events (myocardial infarction, stroke, cardiovascular death) and all-cause mortality were documented to 6 months. About one third of smokers persisted in smoking. Adherence to neither diet nor exercise recommendations was reported by 28.5%, adherence to either diet or exercise by 41.6%, and adherence to both by 29.9%. In contrast, 96.1% of subjects reported antiplatelet use, 78.9% reported statin use, and 72.4% reported angiotensin-converting enzyme/angiotensin receptor blocker use. Quitting smoking was associated with a decreased risk of myocardial infarction compared with persistent smoking (odds ratio, 0.57; 95% confidence interval, 0.36 to 0.89). Diet and exercise adherence was associated with a decreased risk of myocardial infarction compared with nonadherence (odds ratio, 0.52; 95% confidence interval, 0.4 to 0.69). Patients who reported persistent smoking and nonadherence to diet and exercise had a 3.8-fold (95% confidence interval, 2.5 to 5.9) increased risk of myocardial infarction/stroke/death compared with never smokers who modified diet and exercise. Adherence to behavioral advice (diet, exercise, and smoking cessation) after acute coronary syndrome was associated with a substantially lower risk of recurrent cardiovascular events. These findings suggest that behavioral modification should be given priority similar to other preventive medications immediately after acute coronary

  6. Cascading Events, Technology and the Floods Directive: future challenges

    Directory of Open Access Journals (Sweden)

    Pescaroli Gianluca

    2016-01-01

    Full Text Available Cascading events can be referred to multidimensional disasters, where a primary trigger generates a nonlinear series of secondary emergencies that escalate in time, becoming eventually the priority to tackle. In this process, critical infrastructure can be handled as roots of vulnerabilities, because they accumulate both physical attributes and functional nodes. When compromised, they produce widespread breakdowns of society, but also orient emergency responses and long-term recovery. Although floods have been widely associated to the failure of vulnerable equipments or to the disruption of strategic sectors such as energy, communication and transportation, their integration with the emerging concept of cascading has been limited. This open topic presents many challenges for scholars, researchers and practitioners, in particular when the implementation of the EU Floods Directive is considered. The paper presents an overview of the Floods Directive and its relation with the cascading events, using case studies and examples from the existing literature to point out missing links and gaps in the legislation. Conclusions argue that the Directive considers only local geographical scales and limited temporal horizons, which can be result inadequate to limit the escalation of events.

  7. The devil is in the details: Comparisons of episodic simulations of positive and negative future events.

    Science.gov (United States)

    Puig, Vannia A; Szpunar, Karl K

    2017-08-01

    Over the past decade, psychologists have devoted considerable attention to episodic simulation-the ability to imagine specific hypothetical events. Perhaps one of the most consistent patterns of data to emerge from this literature is that positive simulations of the future are rated as more detailed than negative simulations of the future, a pattern of results that is commonly interpreted as evidence for a positivity bias in future thinking. In the present article, we demonstrate across two experiments that negative future events are consistently simulated in more detail than positive future events when frequency of prior thinking is taken into account as a possible confounding variable and when level of detail associated with simulated events is assessed using an objective scoring criterion. Our findings are interpreted in the context of the mobilization-minimization hypothesis of event cognition that suggests people are especially likely to devote cognitive resources to processing negative scenarios. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. Contribution of past and future self-defining event networks to personal identity.

    Science.gov (United States)

    Demblon, Julie; D'Argembeau, Arnaud

    2017-05-01

    Personal identity is nourished by memories of significant past experiences and by the imagination of meaningful events that one anticipates to happen in the future. The organisation of such self-defining memories and prospective thoughts in the cognitive system has received little empirical attention, however. In the present study, our aims were to investigate to what extent self-defining memories and future projections are organised in networks of related events, and to determine the nature of the connections linking these events. Our results reveal the existence of self-defining event networks, composed of both memories and future events of similar centrality for identity and characterised by similar identity motives. These self-defining networks expressed a strong internal coherence and frequently organised events in meaningful themes and sequences (i.e., event clusters). Finally, we found that the satisfaction of identity motives in represented events and the presence of clustering across events both contributed to increase in the perceived centrality of events for the sense of identity. Overall, these findings suggest that personal identity is not only nourished by representations of significant past and future events, but also depends on the formation of coherent networks of related events that provide an overarching meaning to specific life experiences.

  9. One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study

    Directory of Open Access Journals (Sweden)

    Itamar Souza Santos

    2015-01-01

    Full Text Available Background: Information about post-acute coronary syndrome (ACS survival have been mostly short-term findings or based on specialized, cardiology referral centers. Objectives: To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO cohort, and to study baseline characteristics as predictors. Methods: We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality. Results: We identified 110 deaths in the cohort (case-fatality rate, 12.0%. Age [Hazard ratio (HR = 2.04 per 10 year increase; 95% confidence interval (95%CI = 1.75–2.38], non-ST elevation myocardial infarction (HR = 3.82 ; 95%CI = 2.21–6.60 or ST elevation myocardial infarction (HR = 2.59; 95%CI = 1.38–4.89 diagnoses, and diabetes (HR = 1.78; 95%CI = 1.20‑2.63 were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95%CI = 1.04–2.50, but not for cardiovascular mortality. Conclusion: We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in São Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one‑year survival for overall and cardiovascular-related causes.

  10. Launch of the "MICE Procurement" website for your future events

    CERN Multimedia

    The MICE Office team

    2014-01-01

    The number of MICE (Meeting, Incentive, Conference and Event) requests is on the increase and our hotel offer is constantly being developed.   The MICE Office has decided to create a dedicated website in order to offer the best possible service to its users. This site is accessible from the FP webpage (MICE Procurement) using your NICE login. It gives you access to the list of the establishments which have a contract with CERN, grouped by geographic area/star rating, and all related information. The establishments listed on this website can accommodate your local events, organised by CERN or in partnership with an institution. They were selected following a market survey and as a result of a price enquiry in accordance with CERN's Purchasing Rules. We offer a number of standard packages, but we will try to respond to any specific requirements. On the same site you can also access a longer list of hotels (also accessible via the GS website) for which prices and conditions have been nego...

  11. Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials.

    Science.gov (United States)

    Mega, J L; Stitziel, N O; Smith, J G; Chasman, D I; Caulfield, M; Devlin, J J; Nordio, F; Hyde, C; Cannon, C P; Sacks, F; Poulter, N; Sever, P; Ridker, P M; Braunwald, E; Melander, O; Kathiresan, S; Sabatine, M S

    2015-06-06

    Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy. A community-based cohort study (the Malmo Diet and Cancer Study) and four randomised controlled trials of both primary prevention (JUPITER and ASCOT) and secondary prevention (CARE and PROVE IT-TIMI 22) with statin therapy, comprising a total of 48,421 individuals and 3477 events, were included in these analyses. We studied the association of a genetic risk score based on 27 genetic variants with incident or recurrent coronary heart disease, adjusting for traditional clinical risk factors. We then investigated the relative and absolute risk reductions in coronary heart disease events with statin therapy stratified by genetic risk. We combined data from the different studies using a meta-analysis. When individuals were divided into low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk categories, a significant gradient in risk for incident or recurrent coronary heart disease was shown. Compared with the low genetic risk category, the multivariable-adjusted hazard ratio for coronary heart disease for the intermediate genetic risk category was 1·34 (95% CI 1·22-1·47, pgenetic risk category was 1·72 (1·55-1·92, pgenetic risk categories. Similarly, we noted greater absolute risk reductions in those individuals in higher genetic risk categories (p=0·0101), resulting in a roughly threefold decrease in the number needed to treat to prevent one coronary heart disease event in the primary prevention trials. Specifically, in the primary prevention trials, the number needed to treat to prevent one such event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high

  12. Association between red cell distribution width and the risk of heart events in patients with coronary artery disease.

    Science.gov (United States)

    Li, Weimin; Li, Xiaoting; Wang, Maofeng; Ge, Xuan; Li, Feixiang; Huang, Bian; Peng, Jiren; Li, Guohong; Lu, Liang; Yu, Zhuoyuan; Ma, Jiaojiao; Xu, Liaohang; Jin, Meijuan; Si, Hongping; Wan, Rugen

    2015-04-01

    Red cell distribution width (RDW) has been found to be a novel prognostic biomarker in patients with coronary artery disease (CAD); however, the association between RDW and the risk of heart events in patients with CAD is yet to be fully elucidated. Thus, the aim of the present study was to determine whether an elevated RDW was associated with the Framingham risk score (FRS) in patients with CAD. Data were retrospectively collected from Affiliated Dongyang Hospital of Wenzhou Medical University (Dongyang, China). The patients had undergone a coronary angiography and their clinical data were integrated. The patients (male, 260; female, 132) were divided into two groups based on the results of the coronary angiography, namely the CAD (n=283) and control groups (n=109). The FRS was calculated for all the subjects, and complete blood count testing with biochemical measurements was performed. The mean RDW level was 13.7±1.8% in the CAD group and 13.1±1.0% in the control group, while the mean FRS was 9.0±4.9 in the CAD group and 6.4±3.9 in the control group. The RDW and FRS were significantly higher in the CAD group compared with the control group (P0.05). The RDW was shown to significantly correlate with the red blood cell (RBC) count ( r =-0.133, P=0.029), hemoglobin level ( r =-0.207, P=0.001) and TG level ( r =0.226, P<0.001) within the laboratory parameters, as well as the FRS ( r =0.206, P<0.001). In the stepwise multivariate linear regression, which included the RBC count, hemoglobin level, TG level and RDW, the FRS was predicted by hemoglobin ( r 2 =0.034, P=0.001), TG ( r 2 =0.059, P<0.001) and RDW ( r 2 =0.030, P=0.003) parameters. Therefore, a novel association was revealed between higher levels of RDW and an elevated FRS in patients with CAD, which raises the possibility that a simple marker, RDW, may be associated with an increased risk of heart events in CAD patients.

  13. Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

    Science.gov (United States)

    Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

    2016-01-01

    Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

  14. Lipoprotein predictors of cardiovascular events in statin-treated patients with coronary heart disease

    DEFF Research Database (Denmark)

    Holme, Ingar; Cater, Nilo B; Faergeman, Ole

    2008-01-01

    to predict CHD events and to what degree differences in those parameters could explain the observed outcome. METHODS: We compared the ability of treatment with atorvastatin 80 mg/day to that of simvastatin 20-40 mg/day to prevent CHD events in patients with CHD and used Cox regression models to study...

  15. The impact of different doses of clopidogrel used after percutaneous coronary intervention on cardiovascular events: a Meta-analysis

    International Nuclear Information System (INIS)

    Li Diangeng; Chen Yao; Li Rongshan

    2011-01-01

    Objective: To make a comprehensive evaluation of the efficacy and safety of different doses of clopidogrel that was used after percutaneous coronary intervention (PCI) in preventing the cardiovascular events in order to provide scientific basis for physician in making therapeutic strategic decision. Methods: The authors searched the electronic databases (PubMed, Cochrane Central Register of Controlled Trials, CNKI and Wan Fan) and reference lists from original studies and reviewed the related articles.Statistical analysis was performed by using RevMan 4.2 software. Results: A total of 6 studies containing 1027 patients were included. The results of meta-analysis showed that significant differences in the rate of cardiovascular events [OR = 0.52, 95%CI (0.36, 0.77)] existed between higher clopidogrel maintenance dose and standard dose. No obvious difference was found in major or minor bleeding [OR=1.25, 95%CI(0.43, 3.63)] and [OR = 1.25, 95%CI (0.77, 2.02)]. Conclusion: A higher maintenance dose of clopidogrel employed in patients undergoing PCI can reduce the occurrence of cardiovascular events after PCI without increasing the bleeding risk. (J Intervent Radiol, 2011, 20 : 97-102) (authors)

  16. Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital: design and development of a randomised controlled trial.

    NARCIS (Netherlands)

    Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.

    2014-01-01

    Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to

  17. Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital - design and development of a randomised controlled trial

    NARCIS (Netherlands)

    Kasteleyn, M.J.; Gorter, K.J.; Stellato, R.K.; Rijken, M.; Nijpels, G.; Rutten, G.E.H.M.

    2014-01-01

    Background: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to

  18. Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events

    DEFF Research Database (Denmark)

    Chen, Marcus Y.; Rochitte, Carlos E.; Arbab-Zadeh, Armin

    2017-01-01

    Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial p...

  19. 20. Prediction of 10-year risk of hard coronary events among Saudi adults based on prevalence of heart disease risk factors

    Directory of Open Access Journals (Sweden)

    Muhammad Adil Soofi

    2015-10-01

    Conclusions: Our study is the first to estimate the 10-year risk of HCE among adults in an emerging country and discovered a significant proportion of younger aged population are at risk for development of hard coronary events. Public awareness programs to control risk factors are warranted.

  20. Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions After an Acute Coronary Syndrome: The Gratitude Research in Acute Coronary Events Study.

    Science.gov (United States)

    Huffman, Jeff C; Beale, Eleanor E; Celano, Christopher M; Beach, Scott R; Belcher, Arianna M; Moore, Shannon V; Suarez, Laura; Motiwala, Shweta R; Gandhi, Parul U; Gaggin, Hanna K; Januzzi, James L

    2016-01-01

    Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associations of baseline optimism and gratitude with subsequent physical activity, prognostic biomarkers, and cardiac rehospitalizations in post-ACS patients. Participants were enrolled during admission for ACS and underwent assessments at baseline (2 weeks post-ACS) and follow-up (6 months later). Associations between baseline positive psychological constructs and subsequent physical activity/biomarkers were analyzed using multivariable linear regression. Associations between baseline positive constructs and 6-month rehospitalizations were assessed via multivariable Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessments. Baseline optimism was significantly associated with greater physical activity at 6 months (n=153; β=102.5; 95% confidence interval, 13.6-191.5; P=0.024), controlling for baseline activity and sociodemographic, medical, and negative psychological covariates. Baseline optimism was also associated with lower rates of cardiac readmissions at 6 months (n=164), controlling for age, sex, and medical comorbidity (hazard ratio, 0.92; 95% confidence interval, [0.86-0.98]; P=0.006). There were no significant relationships between optimism and biomarkers. Gratitude was minimally associated with post-ACS outcomes. Post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions. Whether interventions that target optimism can successfully increase optimism or improve cardiovascular outcomes in post-ACS patients is not yet known, but can be tested in future studies. URL: http://www.clinicaltrials.gov. Unique

  1. The Effects of Optimism and Gratitude on Physical Activity, Biomarkers, and Readmissions Following an Acute Coronary Syndrome: The Gratitude Research in Acute Coronary Events (GRACE) Study

    Science.gov (United States)

    Huffman, Jeff C.; Beale, Eleanor E.; Celano, Christopher M.; Beach, Scott R.; Belcher, Arianna M.; Moore, Shannon V.; Suarez, Laura; Motiwala, Shweta R.; Gandhi, Parul U.; Gaggin, Hanna; Januzzi, James L.

    2015-01-01

    Background Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associations of baseline optimism and gratitude with subsequent physical activity, prognostic biomarkers, and cardiac rehospitalizations in post-ACS patients. Methods and Results Participants were enrolled during admission for ACS and underwent assessments at baseline (2 weeks post-ACS) and follow-up (6 months later). Associations between baseline positive psychological constructs and subsequent physical activity/biomarkers were analyzed using multivariable linear regression. Associations between baseline positive constructs and 6-month rehospitalizations were assessed via multivariable Cox regression. Overall, 164 participants enrolled and completed the baseline 2-week assessments. Baseline optimism was significantly associated with greater physical activity at 6 months (n=153; β=102.5; 95% confidence interval [13.6-191.5]; p=.024), controlling for baseline activity and sociodemographic, medical, and negative psychological covariates. Baseline optimism was also associated with lower rates of cardiac readmissions at 6 months (N=164), controlling for age, gender, and medical comorbidity (hazard ratio=.92; 95% confidence interval [.86-.98]; p=.006). There were no significant relationships between optimism and biomarkers. Gratitude was minimally associated with post-ACS outcomes. Conclusions Post-ACS optimism, but not gratitude, was prospectively and independently associated with superior physical activity and fewer cardiac readmissions. Whether interventions that target optimism can successfully increase optimism or improve cardiovascular outcomes in post-ACS patients is not yet known, but can be tested in future studies. Clinical

  2. Vertical displacement events: a serious concern in future ITER operation

    International Nuclear Information System (INIS)

    Hassanein, A.; Sizyuk, T.; Ulrickson, M.

    2007-01-01

    The strongly elongated plasma configuration in ITER-like devices is vertically unstable unless an active control feedback at the vertical position is applied. A malfunction of this feedback system for variety of reasons can lead to a rapid plasma vertical displacement at full plasma current. As the plasma contacts the top or bottom of the vacuum vessel, the current is rapidly forced to zero, similar to the behavior of the plasma after the thermal quench of a disruption. This phenomenon constitutes the vertical displacement events (VDE). This can result in melting and vaporization of the plasma-facing component (PFC) as well as melting of the copper substrate and burnout of the coolant channels. The upgraded HEIGHTS simulation package is used to simulate in full 3D the response of an entire ITER module response to a VDE. The initial temperature distribution of the PFC and the bulk substrate prior to the VDE is calculated according to steady state heat flux, module design, and initial coolant temperature. The models used in the upgraded HEIGHTS were recently benchmarked against VDE simulation experiments using powerful electron beam and show an excellent agreement with the data.The surface temperature can then be very high and could result in significant melting of substrate copper and damage the coolant channels. In the case of Be surface, surface vaporization is quite high and will remove most incoming plasma power at typical ITER VDE condition. Therefore, the transmitted heat flux to the substrate and the coolant channels are low enough to cause any significant damage. However, if tungsten is exposed to the VDE the situation is quite different. No significant surface vaporization will occur at the tungsten surface thus, leaving the majority of the incident plasma power to be conducted to the copper substrate causing melting at the interface and burnout of coolant channel with serious implications on the integrity and subsequent performance of this module. The

  3. Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis.

    Science.gov (United States)

    Li, Jian; Zhang, Min; Loerbroks, Adrian; Angerer, Peter; Siegrist, Johannes

    2015-01-01

    Though much evidence indicates that work stress increases the risk of incident of coronary heart disease (CHD), little is known about the role of work stress in the development of recurrent CHD events. The objective of this study was to review and synthesize the existing epidemiological evidence on whether work stress increases the risk of recurrent CHD events in patients with the first CHD. A systematic literature search in the PubMed database (January 1990 - December 2013) for prospective studies was performed. Inclusion criteria included: peer-reviewed English papers with original data, studies with substantial follow-up (> 3 years), end points defined as cardiac death or nonfatal myocardial infarction, as well as work stress assessed with reliable and valid instruments. Meta-analysis using random-effects modeling was conducted in order to synthesize the observed effects across the studies. Five papers derived from 4 prospective studies conducted in Sweden and Canada were included in this systematic review. The measurement of work stress was based on the Demand- Control model (4 papers) or the Effort-Reward Imbalance model (1 paper). According to the estimation by meta-analysis based on 4 papers, a significant effect of work stress on the risk of recurrent CHD events (hazard ratio: 1.65, 95% confidence interval: 1.23-2.22) was observed. Our findings suggest that, in patients with the first CHD, work stress is associated with an increased relative risk of recurrent CHD events by 65%. Due to the limited literature, more well-designed prospective research is needed to examine this association, in particular, from other than western regions of the world. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  4. Impact of metabolic syndrome and diabetes mellitus on cardiovascular events in coronary artery disease without ischemia on stress thallium-201 single photon emission computed tomography after percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Mori, Takao; Ohashi, Yoshitaka; Ejiri, Junya; Takatsuki, Kiyonobu; Ichikawa, Shinobu; Awano, Kojiro

    2005-01-01

    The metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) is a predictor of cardiovascular events. However, the significance of metabolic syndrome for cardiovascular events has been not clarified in Japan. The impact of metabolic syndrome and diabetes mellitus on cardiovascular events was investigated, especially in the high risk group after percutaneous coronary intervention. We studied 456 patients (mean age 63±10 years, range 36-88 years) without ischemia on stress thallium-201 single photon emission computed tomography after percutaneous coronary intervention. The diagnosis of metabolic syndrome was made according to the modified NCEP ATP III criteria. Cardiovascular events were examined for mean 3.7±1.8 years (range 2.0-8.7 years). There were 196 patients without diabetes mellitus or metabolic syndrome (Group D-M-), 89 patients without diabetes mellitus but with metabolic syndrome (Group D-M+), 61 patients with diabetes mellitus but without metabolic syndrome (Group D+M-), and 110 patients with both diabetes mellitus and metabolic syndrome (Group D+M+). The event-free survival curve in Group D-M+ was significantly lower than that in Group D-M- (p<0.05), but not different from that in Group D+M-. The survival curve was markedly lower in Group D+M+ than that in Group D-M+ (p<0.005). The Cox proportional hazard model revealed that diabetes mellitus and metabolic syndrome were independent significant risk factors for events. The diagnosis of metabolic syndrome was helpful for identification of patients with high cardiovascular event rate even in patients after percutaneous coronary intervention. The combination of metabolic syndrome and diabetes mellitus markedly increases the risk for cardiovascular events. (author)

  5. The Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRA*CER) trial: study design and rationale.

    Science.gov (United States)

    2009-09-01

    The protease-activated receptor 1 (PAR-1), the main platelet receptor for thrombin, represents a novel target for treatment of arterial thrombosis, and SCH 530348 is an orally active, selective, competitive PAR-1 antagonist. We designed TRA*CER to evaluate the efficacy and safety of SCH 530348 compared with placebo in addition to standard of care in patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) and high-risk features. TRA*CER is a prospective, randomized, double-blind, multicenter, phase III trial with an original estimated sample size of 10,000 subjects. Our primary objective is to demonstrate that SCH 530348 in addition to standard of care will reduce the incidence of the composite of cardiovascular death, myocardial infarction (MI), stroke, recurrent ischemia with rehospitalization, and urgent coronary revascularization compared with standard of care alone. Our key secondary objective is to determine whether SCH 530348 will reduce the composite of cardiovascular death, MI, or stroke compared with standard of care alone. Secondary objectives related to safety are the composite of moderate and severe GUSTO bleeding and clinically significant TIMI bleeding. The trial will continue until a predetermined minimum number of centrally adjudicated primary and key secondary end point events have occurred and all subjects have participated in the study for at least 1 year. The TRA*CER trial is part of the large phase III SCH 530348 development program that includes a concomitant evaluation in secondary prevention. TRA*CER will define efficacy and safety of the novel platelet PAR-1 inhibitor SCH 530348 in the treatment of high-risk patients with NSTE ACS in the setting of current treatment strategies.

  6. Association of type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population.

    Science.gov (United States)

    Svansdottir, Erla; Denollet, Johan; Thorsson, Bolli; Gudnason, Thorarinn; Halldorsdottir, Sigrun; Gudnason, Vilmundur; van den Broek, Krista C; Karlsson, Hrobjartur D

    2013-04-01

    Type D personality is associated with an increased morbidity and mortality risk in cardiovascular disease patients, but the mechanisms explaining this risk are unclear. We examined whether Type D was associated with coronary artery disease (CAD) risk factors, estimated risk of developing CAD, and previous cardiac events. Cross-sectional study in the general Icelandic population. A random sample of 4753 individuals (mean age 49.1 ± 12.0 years; 49% men) from the REFINE-Reykjavik study completed assessments for Type D personality and conventional CAD risk factors. Ten-year risk of developing CAD was estimated with the Icelandic risk calculator. Type D personality (22% of sample) was associated with a higher prevalence of hypertension (35 vs. 31%, p = 0.009), but less use of hypertension medication (58 vs. 65%, p = 0.013) in hypertensives, more diabetes (6 vs. 4%, p = 0.023), wider waist circumference (p = 0.007), and elevated body mass index (p = 0.025) and blood lipids (p lifestyle-related CAD risk factors, a higher estimated risk of developing CAD, and higher incidence of previous cardiac events. Unhealthy lifestyles may partly explain the adverse cardiovascular effect of Type D personality.

  7. The development of future thinking: young children's ability to construct event sequences to achieve future goals.

    Science.gov (United States)

    Prabhakar, Janani; Hudson, Judith A

    2014-11-01

    Previous studies suggest that the ability to think about and act on the future emerges between 3 and 5 years of age. However, it is unclear what underlying processes change during the development of early future-oriented behavior. We report three experiments that tested the emergence of future thinking ability through children's ability to explicitly maintain future goals and construct future scenarios. Our main objectives were to examine the effects of goal structure and the effects of working memory demands on children's ability to construct future scenarios and make choices to satisfy future goals. The results indicate that 4-year-olds were able to successfully accomplish two temporally ordered goals even with high working memory demands and a complex goal structure, whereas 3-year-olds were able to accomplish two goals only when the working memory demands were low and the goal structure did not involve additional demands from inferential reasoning and contingencies between the temporally ordered goals. Results are discussed in terms of the development of future thinking in conjunction with working memory, inferential reasoning ability, and goal maintenance abilities. Copyright © 2014. Published by Elsevier Inc.

  8. Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A; Flemming, Kelly D; Fugate, Jennifer E

    2016-05-01

    Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men. Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease. Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. 10-Year Associations Between Tumor Necrosis Factor Receptors 1 and 2 and Cardiovascular Events in Patients With Stable Coronary Heart Disease

    DEFF Research Database (Denmark)

    Carlsson, Axel C; Ruge, Toralph; Kjøller, Erik

    2018-01-01

    BACKGROUND: We aimed to assess the associations and predictive powers between the soluble receptors for tumor necrosis factor (TNF)-α (TNFR1 and TNFR2) and cardiovascular outcomes in patients with stable coronary heart disease. METHODS AND RESULTS: CLARICOR (Effect of Clarithromycin on Mortality...... and Morbidity in Patients With Ischemic Heart Disease) is a randomized clinical trial comparing clarithromycin with placebo in patients with stable coronary heart disease. The primary outcome was a composite of nonfatal acute myocardial infarction, unstable angina pectoris, cerebrovascular disease, and all...... factors improved prediction only modestly (concentrations of circulating TNFR1 and TNFR2 were associated with increased risks of cardiovascular events and mortality in patients with stable coronary heart disease. Yet, the utility of measuring TNFR1 and TNFR2 to improve risk...

  10. Well-being and Anticipation for Future Positive Events: Evidences from an fMRI Study.

    Science.gov (United States)

    Luo, Yangmei; Chen, Xuhai; Qi, Senqing; You, Xuqun; Huang, Xiting

    2017-01-01

    Anticipation for future confers great benefits to human well-being and mental health. However, previous work focus on how people's well-being correlate with brain activities during perception of emotional stimuli, rather than anticipation for the future events. Here, the current study investigated how well-being relates to neural circuitry underlying the anticipating process of future desired events. Using event-related functional magnetic resonance imaging, 40 participants were scanned while they were performing an emotion anticipation task, in which they were instructed to anticipate the positive or neutral events. The results showed that bilateral medial prefrontal cortex (MPFC) were activated during anticipation for positive events relative to neutral events, and the enhanced brain activation in MPFC was associated with higher level of well-being. The findings suggest a neural mechanism by which the anticipation process to future desired events correlates to human well-being, which provide a future-oriented view on the neural sources of well-being.

  11. Thrombogenicity and central pulse pressure to enhance prediction of ischemic event occurrence in patients with established coronary artery disease: The MAGMA-ischemia score.

    Science.gov (United States)

    Bliden, Kevin P; Chaudhary, Rahul; Navarese, Eliano P; Sharma, Tushar; Kaza, Himabindu; Tantry, Udaya S; Gurbel, Paul A

    2018-01-01

    Conventional cardiovascular risk estimators based on clinical demographics have limited prediction of coronary events. Markers for thrombogenicity and vascular function have not been explored in risk estimation of high-risk patients with coronary artery disease. We aimed to develop a clinical and biomarker score to predict 3-year adverse cardiovascular events. Four hundred eleven patients, with ejection fraction ≥40% undergoing coronary angiography, and found to have a luminal diameter stenosis ≥50%, were included in the analysis. Thrombelastography indices and central pulse pressure (CPP) were determined at the time of catheterization. We identified predictors of death, myocardial infarction (MI) or stroke and developed a numerical ischemia risk score. The primary endpoint of cardiovascular death, MI or stroke occurred in 22 patients (5.4%). The factors associated with events were age, prior PCI or CABG, diabetes, CPP, and thrombin-induced platelet-fibrin clot strength, and were included in the MAGMA-ischemia score. The MAGMA-ischemia score showed a c-statistic of 0.85 (95% Confidence Interval [CI] 0.80-0.87; pMAGMA-ischemia score greater than 5 had highest risk to develop clinical events, hazard ratio for the primary endpoint: 13.9 (95% CI 5.8-33.1, pMAGMA-ischemia score yielded a higher discrimination. Inclusion of CPP and assessment of thrombogenicity in a novel score for patients with documented CAD enhanced the prediction of events. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Mediators of the Availability Heuristic in Probability Estimates of Future Events.

    Science.gov (United States)

    Levi, Ariel S.; Pryor, John B.

    Individuals often estimate the probability of future events by the ease with which they can recall or cognitively construct relevant instances. Previous research has not precisely identified the cognitive processes mediating this "availability heuristic." Two potential mediators (imagery of the event, perceived reasons or causes for the…

  13. The Effects of Spatial Contextual Familiarity on Remembered Scenes, Episodic Memories, and Imagined Future Events

    Science.gov (United States)

    Robin, Jessica; Moscovitch, Morris

    2014-01-01

    Several recent studies have explored the effect of contextual familiarity on remembered and imagined events. The aim of this study was to examine the extent of this effect by comparing the effect of cuing spatial memories, episodic memories, and imagined future events with spatial contextual cues of varying levels of familiarity. We used…

  14. Preparing for what might happen: An episodic specificity induction impacts the generation of alternative future events.

    Science.gov (United States)

    Jing, Helen G; Madore, Kevin P; Schacter, Daniel L

    2017-12-01

    A critical adaptive feature of future thinking involves the ability to generate alternative versions of possible future events. However, little is known about the nature of the processes that support this ability. Here we examined whether an episodic specificity induction - brief training in recollecting details of a recent experience that selectively impacts tasks that draw on episodic retrieval - (1) boosts alternative event generation and (2) changes one's initial perceptions of negative future events. In Experiment 1, an episodic specificity induction significantly increased the number of alternative positive outcomes that participants generated to a series of standardized negative events, compared with a control induction not focused on episodic specificity. We also observed larger decreases in the perceived plausibility and negativity of the original events in the specificity condition, where participants generated more alternative outcomes, relative to the control condition. In Experiment 2, we replicated and extended these findings using a series of personalized negative events. Our findings support the idea that episodic memory processes are involved in generating alternative outcomes to anticipated future events, and that boosting the number of alternative outcomes is related to subsequent changes in the perceived plausibility and valence of the original events, which may have implications for psychological well-being. Published by Elsevier B.V.

  15. Heparin monotherapy or bivalirudin during percutaneous coronary intervention in patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease: results from the Evaluation of Drug-Eluting Stents and Ischemic Events registry.

    Science.gov (United States)

    Bangalore, Sripal; Pencina, Michael J; Kleiman, Neal S; Cohen, David J

    2014-06-01

    The use of bivalirudin versus unfractionated heparin monotherapy in patients without ST-segment-elevation myocardial infarction is not well defined. The study population consisted of patients enrolled in the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry with either non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease, who underwent percutaneous coronary intervention with either unfractionated heparin or bivalirudin monotherapy. Propensity score matching was used to adjust for baseline characteristics. The primary bleeding (in-hospital composite bleeding-access site bleeding, thrombolysis in myocardial infarction major/minor bleeding, or transfusion) and primary (in-hospital death/myocardial infarction) and secondary ischemic outcomes (death/myocardial infarction/unplanned repeat revascularization at 12 months) were evaluated. Propensity score matching yielded 1036 patients with non-ST-segment-elevation acute coronary syndromes and 2062 patients with stable ischemic heart disease. For the non-ST-segment-elevation acute coronary syndrome cohort, bivalirudin use was associated with lower bleeding (difference, -3.3% [-0.8% to -5.8%]; P=0.01; number need to treat=30) without increase in either primary (difference, 1.2% [4.1% to -1.8%]; P=0.45) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [1.3% to -1.3%]; P=1.00). Similarly, in the stable ischemic heart disease cohort, bivalirudin use was associated with lower bleeding (difference, -1.8% [-0.4% to -3.3%]; P=0.01; number need to treat=53) without increase in either primary (difference, 0.4% [2.3% to -1.5%]; P=0.70) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [0.7% to -0.7%]; P=1.00) when compared with unfractionated heparin monotherapy. Among patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease undergoing percutaneous coronary intervention, bivalirudin use

  16. Future Events

    Directory of Open Access Journals (Sweden)

    Adli Tıp Uzmanları Derneği ATUD

    1996-07-01

    Full Text Available I.\t5- Marmara Tıp Günleri 16-19 Eylül 1996, The Marmara Oteli Taksim İstanbul. İletişim: Doç.Dr.Berrak Yeğen PK. 175 Kadıköy Tel: 0216 414 47 36 - 414 47 34 Fax: 0216 414 47 31- 325 72 17 - 418 33 27 II.\tEUROTOX’96 in collaboration with the Spanish Association of Toxicology 22-25 Eylüll996, ALICANTE; SPAIN, Secretariat-. Viajes Hispania, S.A. EUROTOX’96 Congress, Maisonnave, 11\t- 70, E-03003 Alicante (Spain. Tel: +34-C9 6-522-83-93; Fax: +34 (9 6-522-98-88 III.\tTürk Nöropsikiyatri Derneği Ruhsal Travma Günleri 10-\t11 Ekim 1996, Savoy Oteli Taksim İstanbul. İletişim:Doç.Dı.M.Raşit Tükel Türk Nöropsikiyatri Derneği, İ.Ü. İstanbul Tıp Fakültesi Psikiyatri Anabilim Dalı Fax: 0212 631 24 00 IV.\t1996 Annual Meeting: Construction Professional Relations in Contemporary Health Care 15-\t16 Ekim 1996, Royal Sonesta, Boston Massachusetts ASLME, 765 Common Wealth Avenue, 16th Floor, Boston, MA, 02215. Tel: (617 262-4990 Fax: (617 437- 7596 Email: aslme@bu.edu V.\tXXI International Congress of the International Academy of Pathology and 12th World Congress of Academic and Environmental Pathology 20-25 Ekim 1996, BUDAPEST, HUNGARY, Secretariat: XII International Congress of The International Academy of Pathology and 12th World Congress of Academic and Environmental Pathology, 2nd Dept, of Pathology Semmelweis Univ. of Medicine, Ü1İÖİ £t 93-, H 1091 Budapest, Hungary. Tel/Fax: +36-1-215-7591, +36-1-215-6921. VI.\tVII.THMTK, VII. Türkiye Hastane Mütehassısları Uluslararası Katdımlı Tıp Kongresi 26-29 Ekim 1996, Antalya İletişim: THMD Başkanı Dr.Cafer Yıldıran Talimhane, Lamartin Cad. 46/4, Eren Apt. 80090 Taksim İstanbul Tel: (0212 250 45 55 -‘238 09 85 VII.\tI. Ulusal Biyolojik Antropoloji Sempozyumu 30-31 Ekim 1996, Ankara Ankara Üniversitesi Dil ve Tarih-Coğrafya Fakültesi Farabi salonu İletişim: Prof.Dr.Erksin Güleç A.Ü. Dil ver Tarih-Coğrafya Fakültesi Fizik ve Paleoantropoloji Bölümü 06100 Sıhhiye Ankara. Tel: 0312 310 32 80/ 17 32- 0312 309 37 6l - 0312 310 57 13 Fax: 0312 310 57 13 E mail: egol-k@servis.net.tr. VIII.\tFall School of Evidence Photography 16-\t18 Kasım 1996, Fiesta Inn 2100 S.Priest Drive Tempe Arizona (800 528-6481 (602 967- 1441 EPIC, 600 Main Street, Honesdale, PA 18431. (800 356-3742 Fax: (717 253- 5011. IX.\tIII World Congress of Bioethics “Bioethics in an Interdependent World” 22-24 Kasim 1996, Secreteriat: III World Congress of Bioethics Pacific Center for Health Policy and Ethics. University of Southern California, Los Angeles, CA. 90089-0071 USA Tel: (213 740-2541 Faximile: (213 740-5502 http://www.usc.edu/dept/lawtib/bioethics/ world- congress.html X.\tIV. Sosyal Psikiyatri Sempozyumu 7-\t9 Mayıs 1997, Adana İletişim: DoçDr. Yunus Emre Evlice Çukurova Üniversitesi Tıp Fakültesi Psikiyatri ABD. 01330 Balcalı ADANA Tel: 0322- 338 68 57 XI.\tThe XVn Congress of the International Academy of Legal Medicine (IALM 20-23 Ağustos 1997, Dublin, Ireland Secretariat: Prof.J.F.A. Harbison, Office of the State Pathologist and T.C.D./R.C.S.I. Dept. öf Forensic Medicine, 188 Pearse Street, Trinity College, Dublin 2. Ireland. Tel: +353-1-671 9835; Fax: +353-1-677 2694 Ms. Louise Louhgran, Confrence Secretary, Royal College of Surgeons in Ireland, 123 Stephen’s Green, Dublin 2, Ireland. XII.\t6th Congress of ESBRA, European Society of Biomedical Research on Alcoholism 28 Haziran-1 Eylül 1997, STOCKHOLM, SWEDEN, Secretariat: Associate Professor Stefan Borg, Karolinska Institute, Dept, of Neuroscience St Görans Hospital, Adress: Psykiatriska Beroendekliniken S:t Görans sjukhus, Box 12557, S-102 29 Stockholm, Sweden. Tel: +46-8-672-14-51; Fax: +46-8-672-19-04

  17. Copeptin in acute coronary syndromes and heart failure management: State of the art and future directions.

    Science.gov (United States)

    Schurtz, Guillaume; Lamblin, Nicolas; Bauters, Christophe; Goldstein, Patrick; Lemesle, Gilles

    2015-01-01

    Over the past two decades, the use of multiple biomarkers has changed cardiovascular disease management. Recently, several trials have assessed the diagnostic and prognostic performances of copeptin, especially in patients with heart failure or acute coronary syndromes. Primary results are interesting, with copeptin looking promising for: the management of patients who present at emergency departments early after chest pain onset and the risk stratification of patients with heart failure. The purpose of this article is to review the data on the place of copeptin in the management of patients with chest pain or heart failure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events

    Directory of Open Access Journals (Sweden)

    William J. Phillips

    2018-03-01

    Full Text Available Background: The identification of coronary artery calcification (CAC detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods: 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results: CAC was identified in 70 patients (26%. CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01 and increased during the period of the study (p < 0.05. Conclusions: CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population. Keywords: Cardiac oncology, Coronary calcification and chest CT

  19. Effect of screening for coronary artery disease using CT angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial.

    Science.gov (United States)

    Muhlestein, Joseph B; Lappé, Donald L; Lima, Joao A C; Rosen, Boaz D; May, Heidi T; Knight, Stacey; Bluemke, David A; Towner, Steven R; Le, Viet; Bair, Tami L; Vavere, Andrea L; Anderson, Jeffrey L

    2014-12-03

    Coronary artery disease (CAD) is a major cause of cardiovascular morbidity and mortality in patients with diabetes mellitus, yet CAD often is asymptomatic prior to myocardial infarction (MI) and coronary death. To assess whether routine screening for CAD by coronary computed tomography angiography (CCTA) in patients with type 1 or type 2 diabetes deemed to be at high cardiac risk followed by CCTA-directed therapy would reduce the risk of death and nonfatal coronary outcomes. The FACTOR-64 study was a randomized clinical trial in which 900 patients with type 1 or type 2 diabetes of at least 3 to 5 years' duration and without symptoms of CAD were recruited from 45 clinics and practices of a single health system (Intermountain Healthcare, Utah), enrolled at a single-site coordinating center, and randomly assigned to CAD screening with CCTA (n = 452) or to standard national guidelines-based optimal diabetes care (n = 448) (targets: glycated hemoglobin level 50 mg/dL [women] or >40 mg/dL [men], triglycerides level <150 mg/dL, systolic blood pressure <120 mm Hg), or aggressive therapy with invasive coronary angiography, was recommended based on CCTA findings. Enrollment occurred between July 2007 and May 2013, and follow-up extended to August 2014. The primary outcome was a composite of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization; the secondary outcome was ischemic major adverse cardiovascular events (composite of CAD death, nonfatal MI, or unstable angina). At a mean follow-up time of 4.0 (SD, 1.7) years, the primary outcome event rates were not significantly different between the CCTA and the control groups (6.2% [28 events] vs 7.6% [34 events]; hazard ratio, 0.80 [95% CI, 0.49-1.32]; P = .38). The incidence of the composite secondary end point of ischemic major adverse cardiovascular events also did not differ between groups (4.4% [20 events] vs 3.8% [17 events]; hazard ratio, 1.15 [95% CI, 0.60-2.19]; P = .68). Among

  20. RANTES/CCL5 and risk for coronary events: Results from the MONICA/KORA Augsburg case-cohort, Athero-express and CARDIoGRAM studies

    OpenAIRE

    Kathiresan, Sekar; Reilly, Muredach; Samani, Nilesh; Schunkert, Heribert; Erdmann, Jeanette; Moll, Frans; Boerwinkle, Eric; Hall, Anne; Hengstenberg, Christian; König, Inke; Laaksonen, Reijo; McPherson, Ruth; Thompson, John; Thorsteinsdottir, Unnur; Ziegler, Andreas

    2011-01-01

    textabstractBackground: The chemokine RANTES (regulated on activation, normal T-cell expressed and secreted)/CCL5 is involved in the pathogenesis of cardiovascular disease in mice, whereas less is known in humans. We hypothesised that its relevance for atherosclerosis should be reflected by associations between CCL5 gene variants, RANTES serum concentrations and protein levels in atherosclerotic plaques and risk for coronary events. Methods and Findings: We conducted a case-cohort study withi...

  1. Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study.

    Science.gov (United States)

    Blaha, Michael J; Budoff, Matthew J; DeFilippis, Andrew P; Blankstein, Ron; Rivera, Juan J; Agatston, Arthur; O'Leary, Daniel H; Lima, Joao; Blumenthal, Roger S; Nasir, Khurram

    2011-08-20

    The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata. Median follow-up was 5·8 years (IQR 5·7-5·9). 444 (47%) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74% of all coronary events were in the 239 (25%) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95% CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment. CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources. National Institutes of Health-National Heart, Lung, and Blood Institute. Copyright © 2011 Elsevier Ltd. All rights

  2. "Heinrich events" (& sediments): A history of terminology and recommendations for future usage

    Science.gov (United States)

    Andrews, John T.; Voelker, Antje H. L.

    2018-05-01

    We document the history of terms used to describe Heinrich (H-) layers and events and which mark major glaciological iceberg discharge events in the North Atlantic. We argue that the usage "Heinrich layer," "Heinrich zone", or "Heinrich event" should be restricted to only those sediments that can be ascribed to an origin from the Hudson Strait Ice Stream and the Laurentide Ice Sheet. We also argue that the commonplace understanding of these events--as dominated by massive iceberg discharges --fails to include the earlier well-documented evidence that these events were also massive meltwater events linked to deposition along the North Atlantic Mid-Ocean Channel (NAMOC) in the Labrador Sea. We make five recommendations for future usage of "Heinrich events," which include: restricting the usage to those events that can be mineralogically/geochemically linked to Hudson Strait; abandoning the term "Heinrich stadial"; and promote local terminology for "ice rafted events" that may be correlated, or not, with Hudson Strait Heinrich events based on calibrated radiocarbon dates or other appropriate chronological markers.

  3. Clinical events in coronary heart disease patients with an ejection fraction of 40% or less: 3-year follow-up results.

    Science.gov (United States)

    Pischke, Claudia R; Elliott-Eller, Melanie; Li, Minmin; Mendell, Nancy; Ornish, Dean; Weidner, Gerdi

    2010-01-01

    It is unclear whether lifestyle changes can delay the need for surgical procedures in coronary heart disease (CHD) patients with asymptomatic reduced left ventricular ejection fraction (LVEF). The aim of this pilot study was to examine whether lifestyle changes can delay the need for surgical procedures in this population. We compared 3-year clinical events in 27 CHD patients eligible to receive revascularization (by insurance standards), but underwent lifestyle changes (low-fat diet, exercise, stress management) instead (intervention group [IG], LVEF Lifestyle Demonstration Project, an insurance-sponsored, community-based, secondary prevention study implemented at 8 hospital sites in the United States. At 3 months, there were more cardiac events in the UCG (6 events) than in the IG (1 event; P changes in lifestyle with no increased risk for cardiac events or overt heart failure over 3 years.

  4. Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study.

    Science.gov (United States)

    Tamez, Hector; Généreux, Philip; Yeh, Robert W; Amin, Amit P; Fan, Weihong; White, Harvey D; Kirtane, Ajay J; Stone, Gregg W; Gibson, C Michael; Harrington, Robert A; Bhatt, Deepak L; Pinto, Duane S

    2018-05-04

    Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies. PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. Bleeding and IPTE, defined as abrupt vessel closure (transient or sustained), new/suspected thrombus, new clot on wire/catheter, no reflow, side-branch occlusion, procedural stent thrombosis or urgent need for CABG were identified. Costs were calculated according to whether a complication occurred and type of event. Multivariate analyses were used to estimate the incremental costs of IPTE and postprocedural events. IPTE occurred in 4.3% and were associated with higher catheterization laboratory and overall index hospitalization costs by $2,734 (95%CI $1,117, $4,351; P = 0.001) and $6,354 (95% CI $4,122, $8,586; P < 0.001), respectively. IPTE were associated with MI (35.4% vs. 3.6%; P < 0.001), out-of-laboratory stent thrombosis (4.2% vs. 0.1%; 0 = 0.005), ischemia driven revascularization (12.5% vs. 0.3%; P < 0.001), but not mortality (2.1% vs. 0.2%; P = 0.12) vs. no procedural thrombotic complication. By comparison, ACUITY minor bleeding increased hospitalization cost by $1,416 (95%CI = 312, $2,519; P = 0.012). ACUITY major bleeding increased cost of hospitalization by $7,894 (95%CI $4,154, $11,635; P < 0.001). IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI. © 2018 Wiley Periodicals, Inc.

  5. Physical activity, C-reactive protein levels and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study

    NARCIS (Netherlands)

    Boekholdt, S. Matthijs; Sandhu, Manjinder S.; Day, Nicholas E.; Luben, Robert; Bingham, Sheila A.; Peters, Ron J. G.; Wareham, Nicholas J.; Khaw, Kay-Tee

    2006-01-01

    BACKGROUND: Physical activity is inversely associated with the risk of future coronary artery disease. Whether this relationship is in part mediated by lower levels of systemic inflammation, as indicated by C-reactive protein concentrations, is unknown. METHODS: We performed a nested case-control

  6. Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure.

    Science.gov (United States)

    Ivanes, Fabrice; Susen, Sophie; Mouquet, Frédéric; Pigny, Pascal; Cuilleret, François; Sautière, Karine; Collet, Jean-Philippe; Beygui, Farzin; Hennache, Bernadette; Ennezat, Pierre Vladimir; Juthier, Françis; Richard, Florence; Dallongeville, Jean; Hillaert, Marieke A; Doevendans, Pieter A; Jude, Brigitte; Bertrand, Michel; Montalescot, Gilles; Van Belle, Eric

    2012-01-01

    Recent studies have demonstrated that aldosterone levels measured in patients with heart failure or acute myocardial infarction (MI) are associated with long-term mortality, but the association with aldosterone levels in patients with coronary artery disease (CAD) outside these specific settings remains unknown. In addition, no clear mechanism has been elucidated to explain these observations. The present study was designed to evaluate the relationship between the level of aldosterone and the risk of death and acute ischaemic events in CAD patients with a preserved left ventricular (LV) function and no acute MI. In 799 consecutive CAD patients referred for elective coronary angioplasty measurements were obtained before the procedure for: aldosterone (median = 25 pg/mL), brain natriuretic peptide (BNP) (median = 35 pg/mL), hsC-reactive protein (median = 4.17 mg/L), and left ventricular ejection fraction (mean = 58%). Patients with acute MI or coronary syndrome (ACS) who required urgent revascularization were not included in the study. The primary endpoint, cardiovascular death, occurred in 41 patients during a median follow-up period of 14.9 months. Secondary endpoints-total mortality, acute ischaemic events (acute MI or ischaemic stroke), and the composite of death and acute ischaemic events-were observed in 52, 54, and 94 patients, respectively. Plasma aldosterone was found to be related to BMI, hypertension and NYHA class, and inversely related to age, creatinine clearance, and use of beta-blockers. Multivariate Cox model analysis demonstrated that aldosterone was independently associated with cardiovascular mortality (P = 0.001), total mortality (P = 0.001), acute ischaemic events (P = 0.01), and the composite of death and acute ischaemic events (P = 0.004). Reclassification analysis, using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), demonstrated incremental predictive value of aldosterone (P acute MI, the level of

  7. Characteristics and Future Changes of Great Mississippi Flood Events in a Global Coupled Climate Model

    Science.gov (United States)

    van der Wiel, K.; Kapnick, S. B.; Vecchi, G.; Smith, J. A.

    2017-12-01

    The Mississippi-Missouri river catchment houses millions of people and much of the U.S. national agricultural production. Severe flooding events can therefore have large negative societal, natural and economic impacts. GFDL FLOR, a global coupled climate model (atmosphere, ocean, land, sea ice with integrated river routing module) is used to investigate the characteristics of great Mississippi floods with an average return period of 100 years. Model experiments under pre-industrial greenhouse gas forcing were conducted for 3400 years, such that the most extreme flooding events were explicitly modeled and the land and/or atmospheric causes could be investigated. It is shown that melt of snow pack and frozen sub-surface water in the Missouri and Upper Mississippi basins prime the river system, subsequently sensitizing it to above average precipitation in the Ohio and Tennessee basins. The months preceding the greatest flooding events are above average wet, leading to moist sub-surface conditions. Anomalous melt depends on the availability of frozen water in the catchment, therefore anomalous amounts of sub-surface frozen water and anomalous large snow pack in winter (Nov-Feb) make the river system susceptible for these great flooding events in spring (Feb-Apr). An additional experiment of 1200 years under transient greenhouse gas forcing (RCP4.5, 5 members) was done to investigate potential future change in flood risk. Based on a peak-over-threshold method, it is found that the number of great flooding events decreases in a warmer future. This decrease coincides with decreasing occurrence of large melt events, but is despite increasing numbers of large precipitation events. Though the model results indicate a decreasing risk for the greatest flooding events, the predictability of events might decrease in a warmer future given the changing characters of melt and precipitation.

  8. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome.

    Science.gov (United States)

    Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

    2017-12-31

    To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.

  9. Immunological and cardiometabolic risk factors in the prediction of type 2 diabetes and coronary events: MONICA/KORA Augsburg case-cohort study.

    Directory of Open Access Journals (Sweden)

    Christian Herder

    Full Text Available BACKGROUND: This study compares inflammation-related biomarkers with established cardiometabolic risk factors in the prediction of incident type 2 diabetes and incident coronary events in a prospective case-cohort study within the population-based MONICA/KORA Augsburg cohort. METHODS AND FINDINGS: Analyses for type 2 diabetes are based on 436 individuals with and 1410 individuals without incident diabetes. Analyses for coronary events are based on 314 individuals with and 1659 individuals without incident coronary events. Mean follow-up times were almost 11 years. Areas under the receiver-operating characteristic curve (AUC, changes in Akaike's information criterion (ΔAIC, integrated discrimination improvement (IDI and net reclassification index (NRI were calculated for different models. A basic model consisting of age, sex and survey predicted type 2 diabetes with an AUC of 0.690. Addition of 13 inflammation-related biomarkers (CRP, IL-6, IL-18, MIF, MCP-1/CCL2, IL-8/CXCL8, IP-10/CXCL10, adiponectin, leptin, RANTES/CCL5, TGF-β1, sE-selectin, sICAM-1; all measured in nonfasting serum increased the AUC to 0.801, whereas addition of cardiometabolic risk factors (BMI, systolic blood pressure, ratio total/HDL-cholesterol, smoking, alcohol, physical activity, parental diabetes increased the AUC to 0.803 (ΔAUC [95% CI] 0.111 [0.092-0.149] and 0.113 [0.093-0.149], respectively, compared to the basic model. The combination of all inflammation-related biomarkers and cardiometabolic risk factors yielded a further increase in AUC to 0.847 (ΔAUC [95% CI] 0.044 [0.028-0.066] compared to the cardiometabolic risk model. Corresponding AUCs for incident coronary events were 0.807, 0.825 (ΔAUC [95% CI] 0.018 [0.013-0.038] compared to the basic model, 0.845 (ΔAUC [95% CI] 0.038 [0.028-0.059] compared to the basic model and 0.851 (ΔAUC [95% CI] 0.006 [0.003-0.021] compared to the cardiometabolic risk model, respectively. CONCLUSIONS: Inclusion of multiple

  10. Effects of Italian smoking regulation on rates of hospital admission for acute coronary events: a country-wide study.

    Directory of Open Access Journals (Sweden)

    Francesco Barone-Adesi

    Full Text Available BACKGROUND: Several studies have reported a reduction in acute coronary events (ACEs in the general population after the enforcement of smoking regulations, although there is uncertainty concerning the magnitude of the effect of such interventions. We conducted a country-wide evaluation of the health effects of the introduction of a smoking ban in public places, using data on hospital admissions for ACEs from the Italian population after the implementation of a national smoking regulation in January 2005. METHODS AND FINDINGS: Rates of admission for ACEs in the 20 Italian regions from January 2002 to November 2006 were analysed using mixed-effect regression models that allowed for long-term trends and seasonality. Standard methods for interrupted time-series were adopted to assess the immediate and gradual effects of the smoking ban. Effect modification by age was investigated, with the assumption that exposure to passive smoking in public places would be greater among young people. In total, 936,519 hospital admissions for ACEs occurred in the Italian population during the study period. A 4% reduction in hospital admissions for ACEs among persons aged less than 70 years was evident after the introduction of the ban (Rate Ratio [RR], 0.96; 95% Confidence Interval [CI], 0.95-0.98. No effect was found among persons aged at least 70 years (RR 1.00; 95% CI 0.99-1.02. Effect modification by age was further suggested by analyses using narrower age categories. CONCLUSIONS: Smoke-free policies can constitute a simple and inexpensive intervention for the prevention of cardiovascular diseases and thus should be included in prevention programmes.

  11. Event visualisation in ATLAS: current software technologies, future prospects and trends

    CERN Document Server

    Bianchi, Riccardo-Maria; The ATLAS collaboration; Moyse, Edward

    2016-01-01

    At the beginning, HEP experiments made use of photographical images both to record and store experimental data and to illustrate their findings. Then the experiments evolved and needed to find ways to visualize their data. With the availability of computer graphics, software packages to display event data and the detector geometry started to be developed. Here a brief history of event displays is presented, with an overview of the different event display tools used today in HEP experiments in general, and in the LHC experiments in particular. Then the case of the ATLAS experiment is considered in more detail and two widely used event display packages are presented, Atlantis and VP1, focusing on the software technologies they employ, as well as their strengths, differences and their usage in the experiment: from physics analysis to detector development, and from online monitoring to outreach and communication. Future development plans and improvements in the ATLAS event display packages will also be discussed,...

  12. The future of event-level information repositories, indexing, and selection in ATLAS

    CERN Document Server

    Barberis, D; The ATLAS collaboration; Dimitrov, G; Doherty, T; Gallas, E; Hrivnac, J; Malon, D; Nairz, A; Nowak, M; Quilty, D; Sorokoletov, R; Van Gemmeren, P; Zhang, Q

    2014-01-01

    ATLAS maintains a rich corpus of event-by-event information that provides a global view of virtually all of the billions of events the collaboration has seen or simulated, along with sufficient auxiliary information to navigate to and retrieve data for any event at any production processing stage. This unique resource has been employed for a range of purposes, from monitoring, statistics, anomaly detection, and integrity checking to event picking, subset selection, and sample extraction. Recent years of data-taking provide a foundation for assessment of how this resource has and has not been used in practice, of the uses for which it should be optimized, of how it should be deployed and provisioned for scalability to future data volumes, and of the areas in which enhancements to functionality would be most valuable. \

  13. Changes of junctions of endothelial cells in coronary sclerosis: A review

    Directory of Open Access Journals (Sweden)

    Li-Zi Zhang

    2016-03-01

    Full Text Available Atherosclerosis, the major cause of cardiovascular diseases, has been a leading contributor to morbidity and mortality in the United States and it has been on the rise globally. Endothelial cell–cell junctions are critical for vascular integrity and maintenance of vascular function. Endothelial cell junctions dysfunction is the onset step of future coronary events and coronary artery disease. Keywords: Coronary atherosclerosis, Junctions, Endothelial cells

  14. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility.

    Science.gov (United States)

    Gale, Catharine R; Batty, G David; Osborn, David P J; Tynelius, Per; Rasmussen, Finn

    2014-01-14

    Depression, anxiety, and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders. Participants were 1 107 524 Swedish men conscripted at a mean age of 18.3 years. Mental disorders were assessed by psychiatric interview on conscription, and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. An increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.62) (depressive disorders) to 1.90 (1.58, 2.38) (alcohol-related disorders). [corrected]. The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24-1.80) (schizophrenia) to 2.82 (2.53-3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes mellitus, and blood pressure measured at conscription, but they were partially attenuated by the adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position. Increased risk of incident CHD is present across a range of mental disorders and is observable when the disorders are diagnosed at a young age.

  15. Remembering the past and imagining the future: common and distinct neural substrates during event construction and elaboration

    OpenAIRE

    Addis, Donna Rose; Wong, Alana T.; Schacter, Daniel L.

    2006-01-01

    People can consciously re-experience past events and pre-experience possible future events. This fMRI study examined the neural regions mediating the construction and elaboration of past and future events. Participants were cued with a noun for 20 seconds and instructed to construct a past or future event within a specified time period (week, year, 5–20 years). Once participants had the event in mind, they made a button press and for the remainder of the 20 seconds elaborated on the event. Im...

  16. A comparative analysis of predictors for 1-year recurrent acute coronary syndromes events, by age group: the Greek observational study of ACS (GREECS).

    Science.gov (United States)

    Panagiotakos, Demosthenes B; Notara, Venetia; Georgousopoulou, Ekavi N; Pitsavos, Christos; Antonoulas, Antonis; Kogias, Yannis; Mantas, Yannis; Stravopodis, Petros; Zombolos, Spyros; Stefanadis, Christodoulos

    2015-02-01

    To evaluate the potential differences in risk factors' profile for in-hospital mortality and up to 1-year prognosis, between younger and older patients with first acute coronary syndromes (ACS). From October 2003 to September 2004, 1323 patients with first ACS event from 6 urban and rural Greek hospitals were enrolled into the study, classified as those period of 6-months, the event-rate was higher among the younger patients (p < 0.001). Current smoking was associated with increased risk of 1-month recurrent events, in patients < 65 years (p < 0.05). Myocardial infarction and history of diabetes were associated with increased risk in older patients (p < 0.1). Age-specific identification of the risk factors for recurrent events may have important clinical and public health implications and lead to the development of more effective risk reduction strategies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Cultural Differences in Young Adults' Perceptions of the Probability of Future Family Life Events.

    Science.gov (United States)

    Speirs, Calandra; Huang, Vivian; Konnert, Candace

    2017-09-01

    Most young adults are exposed to family caregiving; however, little is known about their perceptions of their future caregiving activities such as the probability of becoming a caregiver for their parents or providing assistance in relocating to a nursing home. This study examined the perceived probability of these events among 182 young adults and the following predictors of their probability ratings: gender, ethnicity, work or volunteer experience, experiences with caregiving and nursing homes, expectations about these transitions, and filial piety. Results indicated that Asian or South Asian participants rated the probability of being a caregiver as significantly higher than Caucasian participants, and the probability of placing a parent in a nursing home as significantly lower. Filial piety was the strongest predictor of the probability of these life events, and it mediated the relationship between ethnicity and probability ratings. These findings indicate the significant role of filial piety in shaping perceptions of future life events.

  18. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility

    Science.gov (United States)

    Gale, Catharine R; Batty, G David; Osborn, David P J; Tynelius, Per; Rasmussen, Finn

    2014-01-01

    Background Depression, anxiety and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders. Methods and Results Participants were 1,107,524 Swedish men conscripted at mean age 18.3 years. Mental disorders were assessed by psychiatric interview on conscription and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. Increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.60) (depressive disorders) to 1.92 (1.60, 2.31) (alcohol-related disorders). The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24, 1.80) (schizophrenia) to 2.82 (2.53, 3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes and blood pressure measured at conscription, but were partially attenuated by adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position. Conclusions Increased risk of incident CHD is present across a range of mental disorders and is observable when disorders are diagnosed at a young age. PMID:24190959

  19. Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study.

    Directory of Open Access Journals (Sweden)

    Shaun Scholes

    Full Text Available To estimate the number of coronary heart disease (CHD deaths potentially preventable in England in 2020 comparing four risk factor change scenarios.Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a assuming recent trends will continue; (b assuming optimal but feasible levels already achieved elsewhere; (c an intermediate point, halfway between current and optimal levels; and (d assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980. There would be some 39,720 (37,120-41,900 fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300 in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420 would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains.CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.

  20. Quantifying policy options for reducing future coronary heart disease mortality in England: a modelling study.

    Science.gov (United States)

    Scholes, Shaun; Bajekal, Madhavi; Norman, Paul; O'Flaherty, Martin; Hawkins, Nathaniel; Kivimäki, Mika; Capewell, Simon; Raine, Rosalind

    2013-01-01

    To estimate the number of coronary heart disease (CHD) deaths potentially preventable in England in 2020 comparing four risk factor change scenarios. Using 2007 as baseline, the IMPACTSEC model was extended to estimate the potential number of CHD deaths preventable in England in 2020 by age, gender and Index of Multiple Deprivation 2007 quintiles given four risk factor change scenarios: (a) assuming recent trends will continue; (b) assuming optimal but feasible levels already achieved elsewhere; (c) an intermediate point, halfway between current and optimal levels; and (d) assuming plateauing or worsening levels, the worst case scenario. These four scenarios were compared to the baseline scenario with both risk factors and CHD mortality rates remaining at 2007 levels. This would result in approximately 97,000 CHD deaths in 2020. Assuming recent trends will continue would avert approximately 22,640 deaths (95% uncertainty interval: 20,390-24,980). There would be some 39,720 (37,120-41,900) fewer deaths in 2020 with optimal risk factor levels and 22,330 fewer (19,850-24,300) in the intermediate scenario. In the worst case scenario, 16,170 additional deaths (13,880-18,420) would occur. If optimal risk factor levels were achieved, the gap in CHD rates between the most and least deprived areas would halve with falls in systolic blood pressure, physical inactivity and total cholesterol providing the largest contributions to mortality gains. CHD mortality reductions of up to 45%, accompanied by significant reductions in area deprivation mortality disparities, would be possible by implementing optimal preventive policies.

  1. Physical Responses of Convective Heavy Rainfall to Future Warming Condition: Case Study of the Hiroshima Event

    Directory of Open Access Journals (Sweden)

    Kenshi Hibino

    2018-04-01

    Full Text Available An extreme precipitation event happened at Hiroshima in 2014. Over 200 mm of total rainfall was observed on the night of August 19th, which caused floods and many landslides. The rainfall event was estimated to be a rare event happening once in approximately 30 years. The physical response of this event to the change of the future atmospheric condition, which includes a temperature increase on average and convective stability change, is investigated in the present study using a 27-member ensemble experiment and pseudo global warming downscaling method. The experiment is integrated using the Japan Meteorological Research Institute non-hydrostatic regional climate model. A very high-resolution horizontal grid, 500 m, is used to reproduce dense cumulonimbus cloud formation causing heavy rainfall in the model. The future climate condition determined by a higher greenhouse gas concentration is prescribed to the model, in which the surface air temperature globally averaged is 4 K warmer than that in the preindustrial era. The total amounts of precipitation around the Hiroshima area in the future experiments are closer to or slightly lower than in the current experiments in spite of the increase in water vapor due to the atmospheric warming. The effect of the water vapor increase on extreme precipitation is found to be canceled out by the suppression of convection due to the thermal stability enhancement. The fact that future extreme precipitation like the Hiroshima event is not intensified is in contrast to the well-known result that extreme rainfall tends to be intensified in the future. The results in the present study imply that the response of extreme precipitation to global warming differs for each rainfall phenomenon.

  2. The cardiovascular event reduction tool (CERT)--a simplified cardiac risk prediction model developed from the West of Scotland Coronary Prevention Study (WOSCOPS).

    Science.gov (United States)

    L'Italien, G; Ford, I; Norrie, J; LaPuerta, P; Ehreth, J; Jackson, J; Shepherd, J

    2000-03-15

    The clinical decision to treat hypercholesterolemia is premised on an awareness of patient risk, and cardiac risk prediction models offer a practical means of determining such risk. However, these models are based on observational cohorts where estimates of the treatment benefit are largely inferred. The West of Scotland Coronary Prevention Study (WOSCOPS) provides an opportunity to develop a risk-benefit prediction model from the actual observed primary event reduction seen in the trial. Five-year Cox model risk estimates were derived from all WOSCOPS subjects (n = 6,595 men, aged 45 to 64 years old at baseline) using factors previously shown to be predictive of definite fatal coronary heart disease or nonfatal myocardial infarction. Model risk factors included age, diastolic blood pressure, total cholesterol/ high-density lipoprotein ratio (TC/HDL), current smoking, diabetes, family history of fatal coronary heart disease, nitrate use or angina, and treatment (placebo/ 40-mg pravastatin). All risk factors were expressed as categorical variables to facilitate risk assessment. Risk estimates were incorporated into a simple, hand-held slide rule or risk tool. Risk estimates were identified for 5-year age bands (45 to 65 years), 4 categories of TC/HDL ratio ( or = 7.5), 2 levels of diastolic blood pressure ( or = 90 mm Hg), from 0 to 3 additional risk factors (current smoking, diabetes, family history of premature fatal coronary heart disease, nitrate use or angina), and pravastatin treatment. Five-year risk estimates ranged from 2% in very low-risk subjects to 61% in the very high-risk subjects. Risk reduction due to pravastatin treatment averaged 31%. Thus, the Cardiovascular Event Reduction Tool (CERT) is a risk prediction model derived from the WOSCOPS trial. Its use will help physicians identify patients who will benefit from cholesterol reduction.

  3. The future of event-level information repositories, indexing, and selection in ATLAS

    International Nuclear Information System (INIS)

    Barberis, D; Cranshaw, J; Malon, D; Gemmeren, P Van; Zhang, Q; Dimitrov, G; Nairz, A; Sorokoletov, R; Doherty, T; Quilty, D; Gallas, E J; Hrivnac, J; Nowak, M

    2014-01-01

    ATLAS maintains a rich corpus of event-by-event information that provides a global view of the billions of events the collaboration has measured or simulated, along with sufficient auxiliary information to navigate to and retrieve data for any event at any production processing stage. This unique resource has been employed for a range of purposes, from monitoring, statistics, anomaly detection, and integrity checking, to event picking, subset selection, and sample extraction. Recent years of data-taking provide a foundation for assessment of how this resource has and has not been used in practice, of the uses for which it should be optimized, of how it should be deployed and provisioned for scalability to future data volumes, and of the areas in which enhancements to functionality would be most valuable. This paper describes how ATLAS event-level information repositories and selection infrastructure are evolving in light of this experience, and in view of their expected roles both in wide-area event delivery services and in an evolving ATLAS analysis model in which the importance of efficient selective access to data can only grow.

  4. Changes in record-breaking temperature events in China and projections for the future

    Science.gov (United States)

    Deng, Hanqing; Liu, Chun; Lu, Yanyu; He, Dongyan; Tian, Hong

    2017-06-01

    As global warming intensifies, more record-breaking (RB) temperature events are reported in many places around the world where temperatures are higher than ever before http://cn.bing.com/dict/search?q=.&FORM=BDVSP6&mkt=zh-cn. The RB temperatures have caused severe impacts on ecosystems and human society. Here, we address changes in RB temperature events occurring over China in the past (1961-2014) as well as future projections (2006-2100) using observational data and the newly available simulations from the Coupled Model Intercomparison Project Phase 5 (CMIP5). The number of RB events has a significant multi-decadal variability in China, and the intensity expresses a strong decrease from 1961 to 2014. However, more frequent RB events occurred in mid-eastern and northeastern China over last 30 years (1981-2010). Comparisons with observational data indicate multi-model ensemble (MME) simulations from the CMIP5 model perform well in simulating RB events for the historical run period (1961-2005). CMIP5 MME shows a relatively larger uncertainty for the change in intensity. From 2051 to 2100, fewer RB events are projected to occur in most parts of China according to RCP 2.6 scenarios. Over the longer period from 2006 to 2100, a remarkable increase is expected for the entire country according to RCP 8.5 scenarios and the maximum numbers of RB events increase by approximately 600 per year at end of twenty-first century.

  5. Pathological 99mTc-sestamibi myocardial perfusion scintigraphy is independently associated with emerging cardiac events in elderly patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Bucerius, Jan; Joe, Alexius Y.; Herder, Ellen; Brockmann, Holger; Biermann, Kim; Palmedo, Holger; Biersack, Hans-Juergen (Dept. of Nuclear Medicine, Univ. of Bonn (Germany)), e-mail: jan.bucerius@ukb.uni-bonn.de; Tiemann, Klaus (Dept. of Internal Medicine II, Univ. of Bonn (Germany))

    2011-02-15

    Background: Only few data are available regarding the prognostic impact of myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS) regarding emerging cardiac events in elderly patients Purpose: To evaluate the prognostic value of MPS regarding emerging cardiac events in patients aged =70 years with known or suspected coronary artery disease (CAD). Material and Methods: One hundred and thirty-three patients (74.6 +- 3.7 years) who underwent exercise or pharmacological stress/rest MPS were included in this analysis. Semi-quantitative visual interpretation of MPS images was performed and Summed-Stress- (SSS), Summed-Difference- (SDS), and Summed-Rest Scores (SRS) were calculated. Multivariate logistic regression analyses were calculated for evaluation of the independent prognostic impact of MPS results and several cardiac-related patient characteristics with regard to emerging cardiac events. Kaplan-Meier survival- and log rank analyses were calculated for assessment of cardiac event-free survival. Results: Pathological SSS (OR: 3.3), angina (OR: 2.7) and ischemic ECG (OR: 3.0) were independently associated with cardiac events. Patients with pathological SSS (p = 0.005) and ischemic ECG (p = 0.012) had a significantly lower incidence of cardiac event-free survival. Conclusion: Pathological MPS is independently associated with emerging cardiac events predicting a significantly lower incidence of cardiac event-free survival in patients aged =70 years

  6. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Balciunas Mindaugas

    2009-01-01

    Full Text Available C-reactive protein is a powerful independent predictor of cardiovascular events in patients with coronary artery disease. The relation between C-reactive protein (CRP concentration and in-hospital outcome, after coronary artery bypass grafting (CABG, has not yet been established. The study aims to evaluate the predictive value of pre-operative CRP for in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP (hs-CRP levels were measured pre-operatively on the day of surgery in 66 patients scheduled for elective on pump CABG surgery. Post-operative cardiovascular events such as death from cardiovascular causes, ischemic stroke, myocardial damage, myocardial infarction and low output heart failure were recorded. During the first 30 days after surgery, 54 patients were free from observed events and 14 developed the following cardiovascular events: 10 (15% had myocardial damage, four (6% had low output heart failure and two (3% suffered stroke. No patients died during the follow-up period. Serum concentration of hs-CRP ≥ 3.3 mg/l (cut-off point obtained by ROC analysis was related to higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01, myocardial damage (24% vs 6%, P = 0.04 and low output heart failure (12% vs 0%, P = 0.04. Multivariate logistic regression analysis showed that hs-CRP ≥ 3.3 mg/l ( P = 0.002, O.R.: 19.3 (95% confidence interval (CI 2.9-128.0, intra-operative transfusion of red blood cells ( P = 0.04, O.R.: 9.9 (95% C.I. 1.1-85.5 and absence of diuretics in daily antihypertensive treatment ( P = 0.02, O.R.: 15.1 (95% C.I. 1.4-160.6 were independent predictors of combined cardiovascular event. Patients having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an increased risk of post-operative cardiovascular events after on pump coronary artery bypass grafting surgery.

  7. 10-Year Associations Between Tumor Necrosis Factor Receptors 1 and 2 and Cardiovascular Events in Patients With Stable Coronary Heart Disease

    DEFF Research Database (Denmark)

    Carlsson, Axel C.; Ruge, Toralph; Kjøller, Erik

    2018-01-01

    mortality. Patients were followed up for 10 years; discovery sample, those assigned placebo (1204 events in n=1998); and replication sample, those assigned clarithromycin (1220 events in n=1979). We used Cox regression adjusted for C-reactive protein level, established cardiovascular risk factors, kidney.......08-1.24; P0.001 for TNFR2). The associations were similar in the replication sample. The associations with the composite outcome were mainly driven by acute myocardial infarction, cardiovascular mortality, and noncardiovascular mortality. The addition of TNFR1 and TNFR2 to established cardiovascular risk...... factors improved prediction only modestly (TNFR1 and TNFR2 were associated with increased risks of cardiovascular events and mortality in patients with stable coronary heart disease. Yet, the utility of measuring TNFR1 and TNFR2 to improve risk...

  8. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

    Directory of Open Access Journals (Sweden)

    Menozzi Mila

    2012-10-01

    Full Text Available Abstract Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting. Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used. Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

  9. Correlation between peripheral arterial disease and coronary artery disease using ankle brachial index-a study in Indian population

    Directory of Open Access Journals (Sweden)

    Sharmistha Sarangi

    2012-01-01

    Conclusion: There is a definite and strong correlation between PAD and CAD. Correct diagnosis and supervision of patients with PAD is important for preventing the local progression of the disease and effective secondary prevention of future coronary and cerebrovascular events.

  10. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis).

    Science.gov (United States)

    Budoff, Matthew J; Nasir, Khurram; McClelland, Robyn L; Detrano, Robert; Wong, Nathan; Blumenthal, Roger S; Kondos, George; Kronmal, Richard A

    2009-01-27

    In this study, we aimed to establish whether age-sex-specific percentiles of coronary artery calcium (CAC) predict cardiovascular outcomes better than the actual (absolute) CAC score. The presence and extent of CAC correlates with the overall magnitude of coronary atherosclerotic plaque burden and with the development of subsequent coronary events. MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort study of 6,814 asymptomatic participants followed for coronary heart disease (CHD) events including myocardial infarction, angina, resuscitated cardiac arrest, or CHD death. Time to incident CHD was modeled with Cox regression, and we compared models with percentiles based on age, sex, and/or race/ethnicity to categories commonly used (0, 1 to 100, 101 to 400, 400+ Agatston units). There were 163 (2.4%) incident CHD events (median follow-up 3.75 years). Expressing CAC in terms of age- and sex-specific percentiles had significantly lower area under the receiver-operating characteristic curve (AUC) than when using absolute scores (women: AUC 0.73 versus 0.76, p = 0.044; men: AUC 0.73 versus 0.77, p better model fit with the overall score. Both methods robustly predicted events (>90th percentile associated with a hazard ratio [HR] of 16.4, 95% confidence interval [CI]: 9.30 to 28.9, and score >400 associated with HR of 20.6, 95% CI: 11.8 to 36.0). Within groups based on age-, sex-, and race/ethnicity-specific percentiles there remains a clear trend of increasing risk across levels of the absolute CAC groups. In contrast, once absolute CAC category is fixed, there is no increasing trend across levels of age-, sex-, and race/ethnicity-specific categories. Patients with low absolute scores are low-risk, regardless of age-, sex-, and race/ethnicity-specific percentile rank. Persons with an absolute CAC score of >400 are high risk, regardless of percentile rank. Using absolute CAC in standard groups performed better than age-, sex-, and race

  11. Association of Type D personality with unhealthy lifestyle, and estimated risk of coronary events in the general Icelandic population

    NARCIS (Netherlands)

    Svansdóttir, E.; Denollet, J.; Thorsson, B.; Gudnason, T.; Halldorsdottir, S.; Gudnason, V.; van den Broek, K.C.; Karlsson, D.

    2013-01-01

    Background: Type D personality is associated with an increased morbidity and mortality risk in cardiovascular disease patients, but the mechanisms explaining this risk are unclear. We examined whether Type D was associated with coronary artery disease (CAD) risk factors, estimated risk of developing

  12. Intensity changes in future extreme precipitation: A statistical event-based approach.

    Science.gov (United States)

    Manola, Iris; van den Hurk, Bart; de Moel, Hans; Aerts, Jeroen

    2017-04-01

    Short-lived precipitation extremes are often responsible for hazards in urban and rural environments with economic and environmental consequences. The precipitation intensity is expected to increase about 7% per degree of warming, according to the Clausius-Clapeyron (CC) relation. However, the observations often show a much stronger increase in the sub-daily values. In particular, the behavior of the hourly summer precipitation from radar observations with the dew point temperature (the Pi-Td relation) for the Netherlands suggests that for moderate to warm days the intensification of the precipitation can be even higher than 21% per degree of warming, that is 3 times higher than the expected CC relation. The rate of change depends on the initial precipitation intensity, as low percentiles increase with a rate below CC, the medium percentiles with 2CC and the moderate-high and high percentiles with 3CC. This non-linear statistical Pi-Td relation is suggested to be used as a delta-transformation to project how a historic extreme precipitation event would intensify under future, warmer conditions. Here, the Pi-Td relation is applied over a selected historic extreme precipitation event to 'up-scale' its intensity to warmer conditions. Additionally, the selected historic event is simulated in the high-resolution, convective-permitting weather model Harmonie. The initial and boundary conditions are alternated to represent future conditions. The comparison between the statistical and the numerical method of projecting the historic event to future conditions showed comparable intensity changes, which depending on the initial percentile intensity, range from below CC to a 3CC rate of change per degree of warming. The model tends to overestimate the future intensities for the low- and the very high percentiles and the clouds are somewhat displaced, due to small wind and convection changes. The total spatial cloud coverage in the model remains, as also in the statistical

  13. Heinrich Events: An Unintentional Discovery And Possible Consequences For The Future

    Science.gov (United States)

    Heinrich, H.

    2017-12-01

    Heinrich Events: An Unintentional Discovery And Its Possible Consequences For The FutureIn the mid 80ties an environmental impact assessment in relation to deep-sea dumping of medium-to-high level radioactive waste was carried out in the eastern margins of the Mid Atlantic Ridge next to the Bay of Biscaye. In one of the box corers recovered for radionuclide analysis a volcanic rock was found that triggered interest because of an unexpected geochemical feature on its surface. Subsequent investigations on the bordering sediment layer revealed hints on a massive ice rafting event possibly released from rapidly collapsing circum-Atlantic ice shields. The search for more of these events in numerous sediment cores exhibited a total of 11 layers since the end of the Saalian/Illinoian glaciation (OIS 6/5 to 2/1). The six events identified in the period OIS 4 to 2 indicated oceanographic conditions in the Northeast Atlantic Ocean that were different to those that prevailed during most time of this glacial period. Later, several authors proposed mechanisms that could have triggered the collapses, e.g. the Binge-Purge model (MacAyeal, 1993) or, access of relatively warm water to the grounding lines in conjunction with isostatic movements (Bassis, 2017). One of the consequences of rapid ice shield collapses is sea level rise. Paleo data report rates of up to several meters per century over a period of several centuries. The process described by Bassis et al. resembles to what nowadays can be observed along the ice margins of Greenland and the Antarctic where (man-made) warmed ocean water attacks the grounding lines. If this initiates something similar to a Heinrich event this is of widespread consequence for coasts, from displacement of populations to marine pollution. Thus, research on past Heinrich Events is important for understanding the future developments of the existing ice shields and climate change.

  14. Technical Meeting on Impact of Fukushima Event on Current and Future Fast Reactor Designs. Working Material

    International Nuclear Information System (INIS)

    2012-01-01

    The overall purpose of the Technical Meeting was to recognize and analyse the implications of the accident occurred at the Fukushima Dai-ichi Nuclear Power Station on current and future fast neutron systems design and operation. The aim was to provide a global forum for discussing the principal lessons learned from this event, and thus to review safety principles and characteristics of existing and future fast neutron concepts, especially in relation with extreme natural events which potentially may lead to severe accident scenarios. The participants also presented and discussed innovative technical solutions, design features and countermeasures for design extension conditions - including earthquakes, tsunami and other extreme natural hazards - which can enhance the safety level of existing and future fast neutron systems. Furthermore, the meeting gave the opportunity to present advanced methods for the evaluation of the robustness of plants against design extension conditions. Another important goal of this TM was to discuss how to harmonize safety approaches and goals for next generation’s fast reactors. Finally, the meeting was intended to identify areas where further research and development in nuclear safety, technology and engineering in the light of the Fukushima accident are needed. In the frame of the implementation of its Nuclear Safety Action Plan endorsed by all Member States, the IAEA will consider these areas as potential technical topics for new Coordinated Research Projects, to be launched in the near future

  15. Technical Meeting on Impact of Fukushima Event on Current and Future Fast Reactor Designs. Presentations

    International Nuclear Information System (INIS)

    2012-01-01

    The overall purpose of the Technical Meeting was to recognize and analyse the implications of the accident occurred at the Fukushima Dai-ichi Nuclear Power Station on current and future fast neutron systems design and operation. The aim was to provide a global forum for discussing the principal lessons learned from this event, and thus to review safety principles and characteristics of existing and future fast neutron concepts, especially in relation with extreme natural events which potentially may lead to severe accident scenarios. The participants also presented and discussed innovative technical solutions, design features and countermeasures for design extension conditions - including earthquakes, tsunami and other extreme natural hazards - which can enhance the safety level of existing and future fast neutron systems. Furthermore, the meeting gave the opportunity to present advanced methods for the evaluation of the robustness of plants against design extension conditions. Another important goal of this TM was to discuss how to harmonize safety approaches and goals for next generation’s fast reactors. Finally, the meeting was intended to identify areas where further research and development in nuclear safety, technology and engineering in the light of the Fukushima accident are needed. In the frame of the implementation of its Nuclear Safety Action Plan endorsed by all Member States, the IAEA will consider these areas as potential technical topics for new Coordinated Research Projects, to be launched in the near future

  16. Possible Future Climate Change Impacts on the Hydrological Drought Events in the Weihe River Basin, China

    Directory of Open Access Journals (Sweden)

    Fei Yuan

    2016-01-01

    Full Text Available Quantitative evaluation of future climate change impacts on hydrological drought characteristics is one of important measures for implementing sustainable water resources management and effective disaster mitigation in drought-prone regions under the changing environment. In this study, a modeling system for projecting the potential future climate change impacts on hydrological droughts in the Weihe River basin (WRB in North China is presented. This system consists of a large-scale hydrological model driven by climate outputs from three climate models (CMs for future streamflow projections, a probabilistic model for univariate drought assessment, and a copula-based bivariate model for joint drought frequency analysis under historical and future climates. With the observed historical climate data as the inputs, the Variable Infiltration Capacity hydrological model projects an overall runoff reduction in the WRB under the Intergovernmental Panel on Climate Change A1B scenario. The univariate drought assessment found that although fewer hydrological drought events would occur under A1B scenario, drought duration and severity tend to increase remarkably. Moreover, the bivariate drought assessment reveals that future droughts in the same return period as the baseline droughts would become more serious. With these trends in the future, the hydrological drought situation in the WRB would be further deteriorated.

  17. The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease

    International Nuclear Information System (INIS)

    Furuhashi, Tatsuhiko; Moroi, Masao; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru

    2010-01-01

    Normal stress myocardial perfusion images (MPI) generally show good prognosis for cardiovascular events. However, chronic kidney disease (CKD) is one of the important risk factors for coronary artery disease (CAD), and the interpretation of normal stress MPI has not been well established in CKD patients with no evidence of CAD. The purpose of this study was to evaluate the long-term prognostic value of stress MPI in CKD patients with no evidence of myocardial ischemia or infarction. Patients who had no history but were suspected of CAD and had normal stress MPI (n=307, male=208, age=67 years, CKD/non-CKD=46/261) were followed-up for 4.5 years. CKD was defined as a glomerular filtration ratio of 2 and/or persistent proteinuria. Cardiac death, non-fatal myocardial infarction, and unstable angina requiring hospitalization were defined as major cardiac events. Major cardiac events were observed in 3 of 261 (1.1%) non-CKD patients and 6 of 46 (13%) CKD patients (p<0.001, with log-rank test). CKD was an independent risk factor for major cardiac events (hazard ratio=13.1, p<0.001, multivariate Cox regression analysis). Normal stress MPI does not always promise a good prognosis for major cardiac events. Even in patients with no evidence of CAD from stress MPI, CKD can be an independent and significant risk factor for major cardiac events. (author)

  18. Plasminogen activator inhibitor-2 polymorphism associates with recurrent coronary event risk in patients with high HDL and C-reactive protein levels.

    Directory of Open Access Journals (Sweden)

    James P Corsetti

    Full Text Available The objective of this work was to investigate whether fibrinolysis plays a role in establishing recurrent coronary event risk in a previously identified group of postinfarction patients. This group of patients was defined as having concurrently high levels of high-density lipoprotein cholesterol (HDL-C and C-reactive protein (CRP and was previously demonstrated to be at high-risk for recurrent coronary events. Potential risk associations of a genetic polymorphism of plasminogen activator inhibitor-2 (PAI-2 were probed as well as potential modulatory effects on such risk of a polymorphism of low-density lipoprotein receptor related protein (LRP-1, a scavenger receptor known to be involved in fibrinolysis in the context of cellular internalization of plasminogen activator/plansminogen activator inhibitor complexes. To this end, Cox multivariable modeling was performed as a function of genetic polymorphisms of PAI-2 (SERPINB, rs6095 and LRP-1 (LRP1, rs1800156 as well as a set of clinical parameters, blood biomarkers, and genetic polymorphisms previously demonstrated to be significantly and independently associated with risk in the study population including cholesteryl ester transfer protein (CETP, rs708272, p22phox (CYBA, rs4673, and thrombospondin-4 (THBS4, rs1866389. Risk association was demonstrated for the reference allele of the PAI-2 polymorphism (hazard ratio 0.41 per allele, 95% CI 0.20-0.84, p=0.014 along with continued significant risk associations for the p22phox and thrombospondin-4 polymorphisms. Additionally, further analysis revealed interaction of the LRP-1 and PAI-2 polymorphisms in generating differential risk that was illustrated using Kaplan-Meier survival analysis. We conclude from the study that fibrinolysis likely plays a role in establishing recurrent coronary risk in postinfarction patients with concurrently high levels of HDL-C and CRP as manifested by differential effects on risk by polymorphisms of several genes linked

  19. The effect of a disease management algorithm and dedicated postacute coronary syndrome clinic on achievement of guideline compliance: results from the parkland acute coronary event treatment study.

    Science.gov (United States)

    Yorio, Jeff; Viswanathan, Sundeep; See, Raphael; Uchal, Linda; McWhorter, Jo Ann; Spencer, Nali; Murphy, Sabina; Khera, Amit; de Lemos, James A; McGuire, Darren K

    2008-01-01

    The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected populations. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes (ACSs) in a largely indigent county hospital setting. Patients admitted for ACS were randomized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit. Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines. Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence-based practice goals. One hundred forty consecutive patients were randomized. A similar proportion of patients returned for study follow-up in both groups at 3 months (54 [79%]/68 in the usual care group vs 57 [79%]/72 in the intervention group; P = 0.97). Among those completing the 3-month visit, a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 (69%) of the usual care patients compared with 35 (57%) of those in the intervention group (P = 0.43). There was no statistical difference in implementation of therapeutic lifestyle changes (smoking cessation, cardiac rehabilitation, or exercise) between groups. Prescription rates of evidence-based therapeutics at 3 months were similar in both groups. The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence-based secondary prevention treatment goals. Despite initially high rates of evidence-based treatment at discharge, adherence with follow-up appointments and sustained implementation of evidence-based therapies remains a significant challenge in this high-risk cohort.

  20. Role of coronary physiology in the contemporary management of coronary artery disease

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-01-01

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually “intermediate” in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID

  1. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  2. Predicting Long-term Ischemic Events Using Routine Clinical Parameters in Patients with Coronary Artery Disease: The OPT-CAD Risk Score.

    Science.gov (United States)

    Han, Yaling; Chen, Jiyan; Qiu, Miaohan; Li, Yi; Li, Jing; Feng, Yingqing; Qiu, Jian; Meng, Liang; Sun, Yihong; Tao, Guizhou; Wu, Zhaohui; Yang, Chunyu; Guo, Jincheng; Pu, Kui; Chen, Shaoliang; Wang, Xiaozeng

    2018-06-05

    The prognosis of patients with coronary artery disease (CAD) at hospital discharge was constantly varying, and post-discharge risk of ischemic events remain a concern. However, risk prediction tools to identify risk of ischemia for these patients has not yet been reported. We sought to develop a scoring system for predicting long-term ischemic events in CAD patients receiving antiplatelet therapy that would be beneficial in appropriate personalized decision-making for these patients. In this prospective Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD, NCT01735305) registry, a total of 14,032 patients with CAD receiving at least one kind of antiplatelet agent were enrolled from 107 centers across China, from January 2012 to March 2014. The risk scoring system was developed in a derivation cohort (enrolled initially 10,000 patients in the database) using a logistic regression model and was subsequently tested in a validation cohort (the last 4,032 patients). Points in risk score was assigned based on the multivariable odds ratio of each factor. Ischemic events were defined as the composite of cardiac death, myocardial infarction or stroke. Ischemic events occurred in 342 (3.4%) patients in the derivation cohort and 160 (4.0%) patients in the validation cohort during 1-year follow-up. The OPT-CAD score, ranging from 0-257 points, consist of 10 independent risk factors, including age (0-71 points), heart rates (0-36 points), hypertension (0-20 points), prior myocardial infarction (16 points), prior stroke (16 points), renal insufficient (21 points), anemia (19 points), low ejection fraction (22 points), positive cardiac troponin (23 points) and ST-segment deviation (13 points). In predicting 1-year ischemic events, the area under receiver operating characteristics curve were 0.73 and 0.72 in derivation and validation cohort, respectively. The incidences of ischemic events in low- (0-90 points), medium- (91-150 points) and

  3. Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

    International Nuclear Information System (INIS)

    Gu, Hui; Gao, Yang; Hou, Zhihui; Lu, Bin; Schoepf, U.J.; Snyder, Alan N.; Duguay, Taylor M.; Wang, Ximing

    2018-01-01

    To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE). We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined. The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05). Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE. (orig.)

  4. Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Gu, Hui [Shandong University, Department of CT, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong (China); Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing (China); Gao, Yang; Hou, Zhihui; Lu, Bin [Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Beijing (China); Schoepf, U.J.; Snyder, Alan N.; Duguay, Taylor M. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Wang, Ximing [Shandong University, Department of CT, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Jinan, Shandong (China)

    2018-03-15

    To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE). We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined. The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05). Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE. (orig.)

  5. Depression, realism, and the overconfidence effect: are the sadder wiser when predicting future actions and events?

    Science.gov (United States)

    Dunning, D; Story, A L

    1991-10-01

    Do depressed individuals make more realistic judgments than their nondepressed peers in real world settings? Depressed and nondepressed Ss in 2 studies were asked to make predictions about future actions and outcomes that might occur in their personal academic and social worlds. Both groups of Ss displayed overconfidence, that is, they overestimated the likelihood that their predictions would prove to be accurate. Of key importance, depressed Ss were less accurate in their predictions, and thus more overconfident, than their nondepressed counterparts. These differences arose because depressed Ss (a) were more likely to predict the occurrence of low base-rate events and (b) were less likely to be correct when they made optimistic predictions (i.e., stated that positive events would occur or that aversive outcomes would not). Discussion focuses on implications of these findings for the depressive realism hypothesis.

  6. Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI.

    Science.gov (United States)

    Bonzel, Tassilo; Schächinger, Volker; Dörge, Hilmar

    2016-05-01

    We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p PCI patients with MVD (p PCI) rates after a 1.PCI, without

  7. Diagnosis and prognosis of elderly patients with coronary artery disease. Assessment with dipyridamole thallium imaging

    International Nuclear Information System (INIS)

    Yamasaki, Fumiyasu; Takata, Jun; Seo, Hiromi; Chikamori, Taishiro; Yamada, Mitsutoshi; Yabe, Toshikazu; Doi, Yoshinori

    1995-01-01

    The diagnostic and prognostic value of dipyridamole perfusion scintigraphy was assessed in 147 patients with coronary artery disease aged 65 years and older. All patients underwent coronary angiography. Dipyridamole perfusion scintigraphy was performed safely in all patients. Multiple regression analysis showed that fixed defect and reversible defect were powerful detectors of coronary lesions, all patients with fixed disease and 94% of patients with only reversible defects had significant coronary lesion. Diffuse slow washout and ST depression were statistically significant for detection multivessel coronary lesions in patients with fixed disease, the sensitivity and specificity of diffuse slow washout and/or ST depression for detecting multivessel coronary lesions were 85% and 74%, respectively. Cox survival analysis identified diffuse slow washout as the best predictor of future cardiac events among the scintigraphic variables. Univariate analysis showed the best predictors were age (≥70), diffuse slow washout, and severe coronary lesions. Multivariate analysis showed diffuse slow washout and severe coronary lesions were the best predictors. Dividing the patients by age (≥70) showed that age and diffuse slow washout were good predictors. Scintigraphic and angiographic parameters found diffuse slow washout was the only good predictor. Dipyridamole perfusion scintigraphy is useful for the noninvasive detection of significant coronary artery disease in the elderly, and for predicting future cardiac events with similar predictability to angiographic findings. (S.Y.)

  8. International exchange of radiological information in the event of a nuclear accident - future perspectives

    International Nuclear Information System (INIS)

    De-Cort, M.; De-Vries, G.; Breitenbach, L.; Leeb, H.; Weiss, W.

    1996-01-01

    Immediately after the Chernobyl accident most European countries established or enhanced their national radioactivity monitoring and information systems. The large transboundary effect of the radioactive release also triggered the need for bilateral and international agreements on the exchange of radiological information in case of a nuclear accident. Based on the experiences gained from existing bi- and multilateral data exchange the Commission of the European Communities has made provision for and is developing technical systems to exchange information of common interest. Firstly the existing national systems and systems based on bilateral agreements are summarized. The objectives and technical realizations of the EC international information exchange systems ECURIE and EURDEP, are described. The experiences gained over the past few years and the concepts for the future, in which central and eastern European countries will be included, are discussed. The benefits that would result from improving the international exchange of radiological information in the event of a future nuclear accident are further being described

  9. Predictors of coronary heart disease events among asymptomatic persons with low low-density lipoprotein cholesterol MESA (Multi-Ethnic Study of Atherosclerosis).

    Science.gov (United States)

    Blankstein, Ron; Budoff, Matthew J; Shaw, Leslee J; Goff, David C; Polak, Joseph F; Lima, Joao; Blumenthal, Roger S; Nasir, Khurram

    2011-07-19

    Our aim was to identify risk factors for coronary heart disease (CHD) events among asymptomatic persons with low (≤ 130 mg/dl) low-density lipoprotein cholesterol (LDL-C). Even among persons with low LDL-C, some will still experience CHD events and may benefit from more aggressive pharmacologic and lifestyle therapies. The MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective cohort of 6,814 participants free of clinical cardiovascular disease. Of 5,627 participants who were not receiving any baseline lipid-lowering therapies, 3,714 (66%) had LDL-C ≤ 130 mg/dl and were included in the present study. Unadjusted and adjusted hazard ratios were calculated to assess the association of traditional risk factors and biomarkers with CHD events. To determine if subclinical atherosclerosis markers provided additional information beyond traditional risk factors, coronary artery calcium (CAC) and carotid intima media thickness were each separately added to the multivariable model. During a median follow-up of 5.4 years, 120 (3.2%) CHD events were observed. In unadjusted analysis, age, male sex, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol (HDL-C), high triglycerides, and subclinical atherosclerosis markers (CAC >0; carotid intima media thickness ≥1 mm) predicted CHD events. Independent predictors of CHD events included age, male sex, hypertension, diabetes, and low HDL-C. After accounting for all traditional risk factors, the predictive value of CAC was attenuated but remained highly significant. The relationship of all independent clinical predictors remained robust even after accounting for elevated CAC. Among persons with low LDL-C, older age, male sex, hypertension, diabetes, and low HDL-C are associated with adverse CHD events. Even after accounting for all such variables, the presence of CAC provided incremental prognostic value. These results may serve as a basis for deciding which patients with low LDL-C may be considered for

  10. Revascularization for Left Main and Multivessel Coronary Artery Disease: Current Status and Future Prospects after the EXCEL and NOBLE Trials.

    Science.gov (United States)

    Al-Hijji, Mohammed; El Sabbagh, Abdallah; Holmes, David R

    2018-06-01

    Revascularization of severe left main and multivessel coronary artery disease has been shown to improve survival in both stable ischemic heart disease and acute coronary syndrome. While revascularization with coronary artery bypass surgery for these disease entities carries class I recommendation in most current guidelines, recent trials has shown potential comparable survival and cardiovascular outcomes between percutaneous and surgical interventions in patients with less complex coronary anatomy. Despite the conflicting results observed in the most recent left main revascularization trials, Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease (EXCEL) and Nordic-Baltic-British left main revascularization (NOBLE), both treatment strategies remain important for the management of left main disease (LMD) and multivessel disease (MVD) reflecting on the importance of heart team discussion. This review is focused on revascularization of LMD and MVD in patients who are not presenting with ST-segment elevation myocardial infarction, encompassing the evidence from historic and contemporary trials which shaped up current practices. This review discusses the heart team approach to guide decision making, including special populations that are not represented in clinical trials. Copyright © 2018. The Korean Society of Cardiology.

  11. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Directory of Open Access Journals (Sweden)

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  12. Preventable coronary heart disease events from control of cardiovascular risk factors in US adults with diabetes (projections from utilizing the UKPDS risk engine).

    Science.gov (United States)

    Wong, Nathan D; Patao, Christopher; Malik, Shaista; Iloeje, Uchenna

    2014-04-15

    Type 2 diabetes mellitus (T2DM) carries significant risks for coronary heart disease (CHD). We examined the potential US population impact of single and composite risk factor control. Among US adults with diagnosed T2DM aged≥30 years in the National Health and Nutrition Examination Survey 2007 to 2012, we assessed CHD events preventable using the United Kingdom Prospective Diabetes Study CHD risk engine. We examined in all those not at goal the impact of statistical control of smoking, glycated hemoglobin, systolic blood pressure, and total and high-density lipoprotein cholesterol, according to the predefined criteria setting risk factors at different levels of control representing (1) "All to Goal," (2) at "Nominal Control," or (3) at "Aggressive Control." Preventable CHD events represented the difference between the number of events estimated from the control of these risk factors versus current levels of the risk factors. Of 606 men (representing 6.2 million) and 603 women (6.3 million) with DM and no previous CHD, 1.3 million men and 0.7 million women would develop a CHD event within 10 years if left uncontrolled. Controlling all risk factors to goal was projected to prevent 35% and 45% of CHD events in men and women, respectively. Nominal risk factor control was projected to prevent 36% and 38% and aggressive control 51% and 61% of CHD events, respectively. In conclusion, a significant proportion of CHD events in adults with T2DM could be prevented from composite control of risk factors often not at goal. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. A Century of Australian Natural Disasters and How to Reduce the Toll from Future Events

    Science.gov (United States)

    McAneney, J.

    2014-12-01

    This study reviews Australian experience of natural disasters over the last century and considers how to reduce this nation's vulnerability to such events in the future. In line with global experience, the cost of Australian weather-related natural disasters has been increasing, while loss of life has decreased, with extreme heat events responsible for more fatalities than all other natural perils combined, baring epidemics. However when disaster costs arising from historical events are normalised to current day exposure, no long-term trend emerges. Moreover the frequency of these losses shows no sign of increasing since 1950. In other words, the rising cost of natural disasters can be firmly sheeted home to the fact that there are now more of us living in vulnerable places with more to lose. In view of the above, emergency management and government risk management and strategic planning should focus on plausible large event scenarios, whatever their cause. If we wish to reduce disaster losses, land-use planning has to become risk-informed and building codes need to consider potential economic impacts, rather than just life safety. Insurers can play a role by pricing risk correctly and sending clear signals to homeowners (and governments) to stimulate risk-reducing behaviours. The tools to achieve fine-grained risk assessments are increasingly available. The success of the regulated use of the building code in tropical cyclone-prone regions in Australia and the performance of modern seismic building codes in New Zealand, shows what can be achieved when there is a demonstrated need and political will.

  14. The Role of Working Memory in the Probabilistic Inference of Future Sensory Events.

    Science.gov (United States)

    Cashdollar, Nathan; Ruhnau, Philipp; Weisz, Nathan; Hasson, Uri

    2017-05-01

    The ability to represent the emerging regularity of sensory information from the external environment has been thought to allow one to probabilistically infer future sensory occurrences and thus optimize behavior. However, the underlying neural implementation of this process is still not comprehensively understood. Through a convergence of behavioral and neurophysiological evidence, we establish that the probabilistic inference of future events is critically linked to people's ability to maintain the recent past in working memory. Magnetoencephalography recordings demonstrated that when visual stimuli occurring over an extended time series had a greater statistical regularity, individuals with higher working-memory capacity (WMC) displayed enhanced slow-wave neural oscillations in the θ frequency band (4-8 Hz.) prior to, but not during stimulus appearance. This prestimulus neural activity was specifically linked to contexts where information could be anticipated and influenced the preferential sensory processing for this visual information after its appearance. A separate behavioral study demonstrated that this process intrinsically emerges during continuous perception and underpins a realistic advantage for efficient behavioral responses. In this way, WMC optimizes the anticipation of higher level semantic concepts expected to occur in the near future. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Usefulness of type D personality in predicting five-year cardiac events above and beyond concurrent symptoms of stress in patients with coronary heart disease

    DEFF Research Database (Denmark)

    Denollet, Johan; Pedersen, Susanne S.; Vrints, Christiaan J

    2006-01-01

    Psychological stress and type D personality have been associated with adverse cardiac prognosis, but little is known about their relative effect on the pathogenesis of coronary heart disease (CHD). "Type D" refers to the tendency to experience negative emotions and to inhibit the expression...... of these emotions in social interactions. We investigated the relative effect of stress and type D personality on prognosis at 5-year follow-up. At baseline, 337 patients with CHD who participated in cardiac rehabilitation filled in the General Health Questionnaire (psychological stress) and the Type D personality.......001) were related to an increased risk of developing a major adverse cardiac event after adjusting for gender, age, and biomedical risk factors. Multivariate analysis yielded left ventricular ejection fraction...

  16. Inflammatory biomarkers, physical activity, waist circumference, and risk of future coronary heart disease in healthy men and women

    NARCIS (Netherlands)

    Rana, Jamal S.; Arsenault, Benoit J.; Després, Jean-Pierre; Côté, Mélanie; Talmud, Philippa J.; Ninio, Ewa; Wouter Jukema, J.; Wareham, Nicholas J.; Kastelein, John J. P.; Khaw, Kay-Tee; Boekholdt, S. Matthijs

    2011-01-01

    The aim of this study was to determine the contribution of physical activity and abdominal obesity to the variation in inflammatory biomarkers and incident coronary heart disease (CHD) in a European population. In a prospective case-control study nested in the European Prospective Investigation into

  17. Self-expanding intracoronary stents in the treatment of coronary artery disease: new developments and future directions

    NARCIS (Netherlands)

    Lu, H.; Grundeken, M. J.; Koch, K. T.; Wykrzykowska, J. J.

    2013-01-01

    The first stent implanted in the human coronary circulation was a self-expandable (SE) stent and was introduced almost simultaneously with the first balloon-expandable (BE) stents in the late 1980s. Nowadays, the majority of the available stents are delivered by balloon expansion. While BE stents

  18. Relative associations between depression and anxiety on adverse cardiovascular events: does a history of coronary artery disease matter? A prospective observational study.

    Science.gov (United States)

    Pelletier, Roxanne; Bacon, Simon L; Arsenault, André; Dupuis, Jocelyn; Laurin, Catherine; Blais, Lucie; Lavoie, Kim L

    2015-12-15

    To assess whether depression and anxiety increase the risk of mortality and major adverse cardiovascular events (MACE), among patients with and without coronary artery disease (CAD). DECADE (Depression Effects on Coronary Artery Disease Events) is a prospective observational study of 2390 patients referred at the Montreal Heart Institute. Patients were followed for 8.8 years, between 1998 and 2009. Depression and anxiety were assessed using a psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD). Outcomes data were obtained from Quebec provincial databases. All-cause mortality and MACE. After adjustment for covariates, patients with depression were at increased risks of all-cause mortality (relative risk (RR)=2.84; 95% CI 1.25 to 6.49) compared with patients without depression. Anxiety was not associated with increased mortality risks (RR=0.86; 95% CI 0.31 to 2.36). When patients were stratified according to CAD status, depression increased the risk of mortality among patients with no CAD (RR=4.39; 95% CI 1.12 to 17.21), but not among patients with CAD (RR=2.32; 95% CI 0.78 to 6.88). Neither depression nor anxiety was associated with MACE among patients with or without CAD. Depression, but not anxiety, was an independent risk factor for all-cause mortality in patients without CAD. The present study contributes to a better understanding of the relative and unique role of depression versus anxiety among patients with versus without CAD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. What follow-up care and self-management support do patients with type 2 diabetes want after their first acute coronary event? A qualitative study.

    Science.gov (United States)

    Kasteleyn, Marise J; Gorter, Kees J; van Puffelen, Anne L; Heijmans, Monique; Vos, Rimke C; Jansen, Hanneke; Rutten, Guy E H M

    2014-10-01

    Despite diabetes patients' efforts to control their disease, many of them are confronted with an acute coronary event. This may evoke depressive feelings and self-management may be complicated. According to the American Diabetes Association, the transition from hospital to home after an acute coronary event (ACE) is a high-risk time for diabetes patients; it should be improved. Before developing an intervention for diabetes patients with an ACE in the period after discharge from hospital, we want to gain a detailed understanding of patients' views, perceptions and feelings in this respect. Qualitative design. Two semi-structured focus groups were conducted with 14 T2DM patients (71% male, aged 61-77 years) with a recent ACE. One focus group with partners (67% male, aged 64-75 years) was held. All interviews were transcribed verbatim and analyzed by two independent researchers. Patients believed that coping with an ACE differs between patients with and without T2DM. They had problems with physical exercise, sexuality and pharmacotherapy. Patients and partners were neither satisfied with the amount of information, especially on the combination of T2DM and ACE, nor with the support offered by healthcare professionals after discharge. Participants would appreciate tailored self-management support after discharge from hospital. Patients with T2DM and their partners lack tailored support after a first ACE. Our findings underpin the ADA recommendations to improve the transition from hospital to home. The results of our study will help to determine the exact content of a self-management support program delivered at home to help this specific group of patients to cope with both conditions. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  20. Syntax Score and Major Adverse Cardiac Events in Patients with Suspected Coronary Artery Disease: Results from a Cohort Study in a University-Affiliated Hospital in Southern Brazil.

    Science.gov (United States)

    Fuchs, Felipe C; Ribeiro, Jorge P; Fuchs, Flávio D; Wainstein, Marco V; Bergoli, Luis C; Wainstein, Rodrigo V; Zen, Vanessa; Kerkhoff, Alessandra C; Moreira, Leila B; Fuchs, Sandra C

    2016-09-01

    The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. O SXescore prediz independentemente MACE em pacientes submetidos a

  1. Usefulness of proteinuria as a prognostic marker of mortality and cardiovascular events among patients undergoing percutaneous coronary intervention (data from the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events [EXCITE] trial).

    Science.gov (United States)

    Mercado, Nestor; Brugts, Jasper J; Ix, Joachim H; Shlipak, Michael G; Dixon, Simon R; Gersh, Bernard J; Lemos, Pedro A; Guarneri, Mimi; Teirstein, Paul S; Wijns, William; Serruys, Patrick W; Boersma, Eric; O'Neill, William W

    2008-11-01

    Proteinuria was associated with cardiovascular events and mortality in community-based cohorts. The association of proteinuria with mortality and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) was unknown. The association of urinary dipstick proteinuria with mortality and cardiovascular events (composite of death, myocardial infarction, or nonhemorrhagic stroke) in 5,835 subjects of the EXCITE trial was evaluated. Dipstick urinalysis was performed before PCI, and proteinuria was defined as trace or greater. Subjects were followed up for 210 days/7 months after enrollment for the occurrence of events. Multivariate Cox regression analysis evaluated the independent association of proteinuria with each outcome. Mean age was 59 years, 21% were women, 18% had diabetes mellitus, and mean estimated glomerular filtration rate was 90 ml/min/1.73 m(2). Proteinuria was present in 750 patients (13%). During follow-up, 22 subjects (2.9%) with proteinuria and 54 subjects (1.1%) without proteinuria died (adjusted hazard ratio 2.83, 95% confidence interval [CI] 1.65 to 4.84, p use tool as urinary dipstick may be useful to identify and treat patients at high risk of mortality at the time of PCI.

  2. A high-speed DAQ framework for future high-level trigger and event building clusters

    International Nuclear Information System (INIS)

    Caselle, M.; Perez, L.E. Ardila; Balzer, M.; Dritschler, T.; Kopmann, A.; Mohr, H.; Rota, L.; Vogelgesang, M.; Weber, M.

    2017-01-01

    Modern data acquisition and trigger systems require a throughput of several GB/s and latencies of the order of microseconds. To satisfy such requirements, a heterogeneous readout system based on FPGA readout cards and GPU-based computing nodes coupled by InfiniBand has been developed. The incoming data from the back-end electronics is delivered directly into the internal memory of GPUs through a dedicated peer-to-peer PCIe communication. High performance DMA engines have been developed for direct communication between FPGAs and GPUs using 'DirectGMA (AMD)' and 'GPUDirect (NVIDIA)' technologies. The proposed infrastructure is a candidate for future generations of event building clusters, high-level trigger filter farms and low-level trigger system. In this paper the heterogeneous FPGA-GPU architecture will be presented and its performance be discussed.

  3. Recent and future warm extreme events and high-mountain slope stability.

    Science.gov (United States)

    Huggel, C; Salzmann, N; Allen, S; Caplan-Auerbach, J; Fischer, L; Haeberli, W; Larsen, C; Schneider, D; Wessels, R

    2010-05-28

    The number of large slope failures in some high-mountain regions such as the European Alps has increased during the past two to three decades. There is concern that recent climate change is driving this increase in slope failures, thus possibly further exacerbating the hazard in the future. Although the effects of a gradual temperature rise on glaciers and permafrost have been extensively studied, the impacts of short-term, unusually warm temperature increases on slope stability in high mountains remain largely unexplored. We describe several large slope failures in rock and ice in recent years in Alaska, New Zealand and the European Alps, and analyse weather patterns in the days and weeks before the failures. Although we did not find one general temperature pattern, all the failures were preceded by unusually warm periods; some happened immediately after temperatures suddenly dropped to freezing. We assessed the frequency of warm extremes in the future by analysing eight regional climate models from the recently completed European Union programme ENSEMBLES for the central Swiss Alps. The models show an increase in the higher frequency of high-temperature events for the period 2001-2050 compared with a 1951-2000 reference period. Warm events lasting 5, 10 and 30 days are projected to increase by about 1.5-4 times by 2050 and in some models by up to 10 times. Warm extremes can trigger large landslides in temperature-sensitive high mountains by enhancing the production of water by melt of snow and ice, and by rapid thaw. Although these processes reduce slope strength, they must be considered within the local geological, glaciological and topographic context of a slope.

  4. The MMP-9 -1562 C/T polymorphism in the presence of metabolic syndrome increases the risk of clinical events in patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Trine B Opstad

    Full Text Available Elevated levels of matrix metalloproteinase (MMP-9 have been associated with the metabolic syndrome (MetS and cardiovascular events. The MMP-9 -1562 C/T polymorphism has furthermore been shown as a risk factor for coronary artery disease (CAD. The non-favourable cardiometabolic state in MetS may increase the risk. We aimed to investigate the influence of MMP-9 -1562 C/T polymorphism in subjects with CAD and MetS.Patients (n = 1000 with verified CAD stratified in Mets +/- (n = 244/756, were analyzed for the MMP-9 -1562 C/T polymorphism and related to clinical events after 2 years follow-up. Serum levels of total MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP-1 were analyzed in all, whereas MMP-9 activity, extracellular matrix metalloproteinase inducer (EMMPRIN, and expression of the two genes were analyzed in a subset of 240 randomly selected patients.Totally, 106 clinical endpoints were recorded. In MetS; the T-allele associated with 5.5 fold increase in event rate (p<0.0001, increased with number of MetS components, a 117% increase in total MMP-9 levels (TT homozygous, p = 0.05, significantly higher total- and endogenous active MMP-9 and TIMP-1 levels (p<0.01 all, and EMMPRIN was inversely correlated with pro- and endogenous active MMP-9 (p<0.05, both. In non-MetS; the T-allele was not associated with new events, nor higher MMP-9 levels. EMMPRIN was significantly correlated with total MMP-9 and TIMP-1 (p<0.01, both and the two genes were inter-correlated (p<0.001.In CAD patients with MetS, the MMP-9 T-allele increased the risk of clinical events, probably mediated through elevated MMP-9 levels and altered MMP-9 regulation.

  5. Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing sirolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registry.

    Science.gov (United States)

    Zhang, Qi; Qiu, Jian-Ping; Zhang, Rui-Yan; Li, Yi-Gang; He, Ben; Jin, Hui-Gen; Zhang, Jun-Feng; Wang, Xiao-Long; Jiang, Li; Liao, Min-Lei; Hu, Jian; Shen, Wei-Feng

    2010-04-05

    Randomized, controlled trials have demonstrated the superiority of sirolimus-eluting stent (SES) implantation during primary percutaneous coronary intervention (PCI), as opposed to bare-metal stents, in patients with ST-elevation myocardial infarction (STEMI). This study aimed to test the hypothesis that clinical benefits of SES treatment were independent of gender in this setting. A total of 2042 patients with STEMI undergoing SES-based primary PCI were prospectively enrolled into Shanghai Acute Coronary Event (SACE) registry (1574 men and 468 women). Baseline demographics, angiographic and PCI features, and in-hospital and 30-day major adverse cardiac events (MACE) were analyzed as a function of gender. Compared with men, women were older and more frequently had hypertension, diabetes, and hypercholesterolemia. Use of platelet glycoprotein IIb/IIIa receptor inhibitor (GPI, 65.5% vs. 62.2%, P = 0.10) and procedural success rate (95.0% vs. 94.2%, P = 0.52) were similar in both genders. In-hospital death and MACE occurred in 3.8% and 7.6%, and 4.5% and 8.1% in the male and female patients, respectively (all P > 0.05). At 30-day follow-up, survival (94.3% vs. 93.8%, P = 0.66) and MACE-free survival (90.2% vs. 89.3%, P = 0.52) did not significantly differ between men and women. After adjustment for differences in patient demographics, angiographic and procedural features, there were no significant difference in either in-hospital (OR = 0.77, 95%CI of 0.48 to 1.22, P = 0.30) or 30-day mortality (OR = 1.28, 95%CI of 0.73 to 2.23, P = 0.38) between women and men. Despite more advanced age and clustering of risk factors in women, female patients with STEMI treated by SES-based primary PCI had similar in-hospital and short-term clinical outcomes as their male counterparts.

  6. Experiencing Past and Future Personal Events: Functional Neuroimaging Evidence on the Neural Bases of Mental Time Travel

    Science.gov (United States)

    Botzung, Anne; Denkova, Ekaterina; Manning, Lilianne

    2008-01-01

    Functional MRI was used in healthy subjects to investigate the existence of common neural structures supporting re-experiencing the past and pre-experiencing the future. Past and future events evocation appears to involve highly similar patterns of brain activation including, in particular, the medial prefrontal cortex, posterior regions and the…

  7. Monitoring of the future strong Vrancea events by using the CN formal earthquake prediction algorithm

    International Nuclear Information System (INIS)

    Moldoveanu, C.L.; Novikova, O.V.; Panza, G.F.; Radulian, M.

    2003-06-01

    The preparation process of the strong subcrustal events originating in Vrancea region, Romania, is monitored using an intermediate-term medium-range earthquake prediction method - the CN algorithm (Keilis-Borok and Rotwain, 1990). We present the results of the monitoring of the preparation of future strong earthquakes for the time interval from January 1, 1994 (1994.1.1), to January 1, 2003 (2003.1.1) using the updated catalogue of the Romanian local network. The database considered for the CN monitoring of the preparation of future strong earthquakes in Vrancea covers the period from 1966.3.1 to 2003.1.1 and the geographical rectangle 44.8 deg - 48.4 deg N, 25.0 deg - 28.0 deg E. The algorithm correctly identifies, by retrospective prediction, the TJPs for all the three strong earthquakes (Mo=6.4) that occurred in Vrancea during this period. The cumulated duration of the TIPs represents 26.5% of the total period of time considered (1966.3.1-2003.1.1). The monitoring of current seismicity using the algorithm CN has been carried out since 1994. No strong earthquakes occurred from 1994.1.1 to 2003.1.1 but the CN declared an extended false alarm from 1999.5.1 to 2000.11.1. No alarm has currently been declared in the region (on January 1, 2003), as can be seen from the TJPs diagram shown. (author)

  8. Long-term follow-up after near-infrared spectroscopy coronary imaging: Insights from the lipid cORe plaque association with CLinical events (ORACLE-NIRS) registry.

    Science.gov (United States)

    Danek, Barbara Anna; Karatasakis, Aris; Karacsonyi, Judit; Alame, Aya; Resendes, Erica; Kalsaria, Pratik; Nguyen-Trong, Phuong-Khanh J; Rangan, Bavana V; Roesle, Michele; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S

    Coronary lipid core plaque may be associated with the incidence of subsequent cardiovascular events. We analyzed outcomes of 239 patients who underwent near-infrared spectroscopy (NIRS) coronary imaging between 2009-2011. Multivariable Cox regression was used to identify variables independently associated with the incidence of major adverse cardiovascular events (MACE; cardiac mortality, acute coronary syndromes (ACS), stroke, and unplanned revascularization) during follow-up. Mean patient age was 64±9years, 99% were men, and 50% were diabetic, presenting with stable coronary artery disease (61%) or an acute coronary syndrome (ACS, 39%). Target vessel pre-stenting median lipid core burden index (LCBI) was 88 [interquartile range, IQR 50-130]. Median LCBI in non-target vessels was 57 [IQR 26-94]. Median follow-up was 5.3years. The 5-year MACE rate was 37.5% (cardiac mortality was 15.0%). On multivariable analysis the following variables were associated with MACE: diabetes mellitus, prior percutaneous coronary intervention performed at index angiography, and non-target vessel LCBI. Non-target vessel LCBI of 77 was determined using receiver-operating characteristic curve analysis to be a threshold for prediction of MACE in our cohort. The adjusted hazard ratio (HR) for non-target vessel LCBI ≥77 was 14.05 (95% confidence interval (CI) 2.47-133.51, p=0.002). The 5-year cumulative incidence of events in the above-threshold group was 58.0% vs. 13.1% in the below-threshold group. During long-term follow-up of patients who underwent NIRS imaging, high LCBI in a non-PCI target vessel was associated with increased incidence of MACE. Published by Elsevier Inc.

  9. Limit structure of future null infinity tangent-topology of the event horizon and gravitational wave tail

    International Nuclear Information System (INIS)

    Tomizawa, Shinya; Siino, Masaru

    2006-01-01

    We investigated the relation between the behaviour of gravitational waves at late time and the limit structure of future null infinity tangent which will determine the topology of the event horizon far in the future. In the present paper, we mainly consider a spacetime with two black holes. Although in most cases, the black holes coalesce and the event horizon is topologically a single sphere far in the future, there are several possibilities that the black holes never coalesce and such exact solutions as examples. In our formulation, the tangent vector of future null infinity is, under conformal embedding, related to the number of black holes far in the future through the Poincare-Hopf theorem. Under the conformal embedding, the topology of the event horizon far in the future will be affected by the geometrical structure of the future null infinity. In this paper, we relate the behaviour of Weyl curvature to this limit behaviour of the generator vector of the future null infinity. We show if Weyl curvature decays sufficiently slowly at late time in the neighbourhood of future null infinity, two black holes never coalesce

  10. Future versus present: time perspective and pupillary response in a relatedness judgment task investigating temporal event knowledge.

    Science.gov (United States)

    Nowack, Kati; Milfont, Taciano L; van der Meer, Elke

    2013-02-01

    Mental representations of events contain many components such as typical agents, instruments, objects as well as a temporal dimension that is directed towards the future. While the role of temporal orientation (chronological, reverse) in event knowledge has been demonstrated by numerous studies, little is known about the influence of time perspective (present or future) as source of individual differences affecting event knowledge. The present study combined behavioral data with task-evoked pupil dilation to examine the impact of time perspective on cognitive resource allocation. In a relatedness judgment task, everyday events like raining were paired with an object feature like wet. Chronological items were processed more easily than reverse items regardless of time perspective. When more automatic processes were applied, greater scores on future time perspective were associated with lower error rates for chronological items. This suggests that a match between a strong focus on future consequences and items with a temporal orientation directed toward the future serves to enhance responding accuracy. Indexed by pupillary data, future-oriented participants invested more cognitive resources while outperforming present-oriented participants in reaction times across all conditions. This result was supported by a principal component analysis on the pupil data, which demonstrated the same impact of time perspective on the factor associated with more general aspects of cognitive effort. These findings suggest that future time perspective may be linked to a more general cognitive performance characteristic that improves overall task performance. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Future cardiac events in patients with ischemic ECG changes during adenosine infusion as a myocardial stress agent and normal cardiac scan.

    Science.gov (United States)

    Amer, Hamid; Niaz, Khalid; Hatazawa, Jun; Gasmelseed, Ahmed; Samiri, Hussain Al; Al Othman, Maram; Hammad, Mai Al

    2017-11-01

    We sought to determine the prognostic importance of adenosine-induced ischemic ECG changes in patients with normal single-photon emission computed tomography myocardial perfusion images (MPI). We carried out a retrospective analysis of 765 patients undergoing adenosine MPI between January 2013 and January 2015. Patients with baseline ECG abnormalities and/or abnormal scan were excluded. Overall, 67 (8.7%) patients had ischemic ECG changes during adenosine infusion in the form of ST depression of 1 mm or more. Of these, 29 [43% (3.8% of all patients)] had normal MPI (positive ECG group). An age-matched and sex-matched group of 108 patients with normal MPI without ECG changes served as control participants (negative ECG group). During a mean follow-up duration of 33.3±6.1 months, patients in the positive ECG group did not have significantly more adverse cardiac events than those in the negative ECG group. One (0.9%) patient in the negative ECG group had a nonfatal myocardial infarction (0.7% annual event rate after a negative MPI). Also in this group, two (1.8%) patients admitted with a diagnosis of CAD where they have been ruled out by angiography. A fourth case in this, in the negative ECG group, was admitted because of heart failure that proved to be secondary to a pulmonary cause and not CAD. A case only in the positive ECG group was admitted as a CAD that was ruled out by coronary angiography. Patients with normal myocardial perfusion scintigraphy in whom ST-segment depression develops during adenosine stress test appear to have no increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia.

  12. Diabetes mellitus, preexisting coronary heart disease, and the risk of subsequent coronary heart disease events in patients infected with human immunodeficiency virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study)

    DEFF Research Database (Denmark)

    Worm, Signe W; De Wit, Stephane; Weber, Rainer

    2009-01-01

    of DM and preexisting CHD on the development of a new CHD episode among 33,347 HIV-infected individuals in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study). METHODS AND RESULTS: Over 159,971 person-years, 698 CHD events occurred. After adjustment for gender, age, cohort, HIV...... transmission, ethnicity, family history of CHD, smoking, and calendar year, the rate of a CHD episode was 7.52 times higher (Poisson regression, 95% CI 6.02 to 9.39, P=0.0001) in those with preexisting CHD than in those without preexisting CHD, but it was only 2.41 times higher (95% CI 1.91 to 3.05, P=0...

  13. Landslide and Tsunami in Karrat Fjord, Greenland, 2017; the Event, the Response and the Future

    Science.gov (United States)

    Langley, K.; Mätzler, E.; Barba, M.; Bojesen, M. H.; Caduff, R.; O'Cofaigh, C.; Dehls, J. F.; 1, G. W. G.; Glimsdal, S.; Harbitz, C. B.; Hermanns, R. L.; Kaab, A.; Kibenich, B.; Kvistedal, Y.; Langeland, H.; Larsen, Y.; Løvholt, F.; Lynett, P. J.; Morin, P. J.; Odermatt, L.; Rignot, E. J.; Sparrevik, P.; Wiesmann, A.; Willis, M.; Zinglersen, K. B.

    2017-12-01

    On the evening of 17 June 2017, a landslide released from a rock slope in the Karrat Fjord, West Greenland. A section 800 m in breadth detached from an elevation of 1000 m a.s.l. and plunged into the fjord below causing a tsunami. The result was loss of life and injury, devastation and evacuation of local villages, and the revelation that the mountain side is unstable in other places. The humanitarian effort, both locally and international to ease the situation for locals has been outstanding. Here we describe how the sequence of events surrounding the landslide unfolded and, thanks to the rapid response and cooperation by a multi-disciplinary, international team of geoscientists, crucial information could be provided to the Greenlandic authorities that supported and aided decision making. Photography and video from the first response teams showed the path of the landslide. Initial analysis of optical (Planet Cubesat constellation, Sentinel-2), SAR (Sentinel-1) and photogrammetric data from before and after the event confirmed the location of the landslide and the area that had detached. By extending the time series of Sentinel-1 data, it was possible to show that the section had been active since March 2017 with displacement accelerating towards failure. The new ArcticDEM was used to give an estimate of area and volume displacement in the main slide. The area where material was lost covered 760 x103 m2 and amounted to a displaced volume of >50 mio m3. These approaches all identified other parts of the mountain side that are in motion. Tsunami modelling was used to predict the on land inundation with simulations based on the landslide dimensions and a bathymetry model from multi beam surveys. The model results matched extremely well with reconstructed run-up heights manually interpreted from video and photographic footage and seismic analyses. For optimizing the guidance of the Greenlandic authorities, all results and experience from the many involved scientists

  14. Quantitative troponin and death, cardiogenic shock, cardiac arrest and new heart failure in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS): insights from the Global Registry of Acute Coronary Events.

    Science.gov (United States)

    Jolly, Sanjit S; Shenkman, Heather; Brieger, David; Fox, Keith A; Yan, Andrew T; Eagle, Kim A; Steg, P Gabriel; Lim, Ki-Dong; Quill, Ann; Goodman, Shaun G

    2011-02-01

    The objective of this study was to determine if the extent of quantitative troponin elevation predicted mortality as well as in-hospital complications of cardiac arrest, new heart failure and cardiogenic shock. 16,318 patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) from the Global Registry of Acute Coronary Events (GRACE) were included. The maximum 24 h troponin value as a multiple of the local laboratory upper limit of normal was used. The population was divided into five groups based on the degree of troponin elevation, and outcomes were compared. An adjusted analysis was performed using quantitative troponin as a continuous variable with adjustment for known prognostic variables. For each approximate 10-fold increase in the troponin ratio, there was an associated increase in cardiac arrest, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) (1.0, 2.4, 3.4, 5.9 and 13.4%; p<0.001 for linear trend), cardiogenic shock (0.5, 1.4, 2.0, 4.4 and 12.7%; p<0.001), new heart failure (2.5, 5.1, 7.4, 11.6 and 15.8%; p<0.001) and mortality (0.8, 2.2, 3.0, 5.3 and 14.0%; p<0.001). These findings were replicated using the troponin ratio as a continuous variable and adjusting for covariates (cardiac arrest, sustained VT or VF, OR 1.56, 95% CI 1.39 to 1.74; cardiogenic shock, OR 1.87, 95% CI 1.61 to 2.18; and new heart failure, OR 1.57, 95% CI 1.45 to 1.71). The degree of troponin elevation was predictive of early mortality (HR 1.61, 95% CI 1.44 to 1.81; p<0.001 for days 0-14) and longer term mortality (HR 1.18, 95% CI 1.07 to 1.30, p=0.001 for days 15-180). The extent of troponin elevation is an independent predictor of morbidity and mortality.

  15. Risk of Adverse Cardiac and Bleeding Events Following Cardiac and Noncardiac Surgery in Patients With Coronary Stent: How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery?

    Science.gov (United States)

    Saia, Francesco; Belotti, Laura Maria Beatrice; Guastaroba, Paolo; Berardini, Alessandra; Rossini, Roberta; Musumeci, Giuseppe; Tarantini, Giuseppe; Campo, Gianluca; Guiducci, Vincenzo; Tarantino, Fabio; Menozzi, Alberto; Varani, Elisabetta; Santarelli, Andrea; Tondi, Stefano; De Palma, Rossana; Rapezzi, Claudio; Marzocchi, Antonio

    2016-01-01

    Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery. Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.6%, 9.4%, 14.3%, and 40.0%, respectively, and of cardiac and noncardiac surgery was 0.8%, 2.1%, 2.6%, and 4.0% and 1.3%, 5.1%, 9.1%, and 31.7%, respectively. We assessed the incidence and the predictors of cardiac death, myocardial infarction, and serious bleeding event within 30 days from surgery. Cardiac death occurred in 438 patients (2.5%), myocardial infarction in 256 (1.5%), and serious bleeding event in 1099 (6.4%). Surgery increased 1.58× the risk of cardiac death during follow-up. Along with other risk factors, the interplay between stent type and time from percutaneous coronary intervention to surgery was independently associated with cardiac death/myocardial infarction. In comparison with bare-metal stent implanted >12 months before surgery, old-generation drug-eluting stent was associated with higher risk of events at any time point. Conversely, new-generation drug-eluting stent showed similar safety as bare-metal stent >12 months and between 6 and 12 months and appeared trendly safer between 0 and 6 months. Surgery is frequent in patients with coronary stents and carries a considerable risk of ischemic and bleeding events. Ischemic risk is inversely related with time from percutaneous coronary intervention to surgery and is influenced by stent type. © 2015 American Heart Association, Inc.

  16. Acute Coronary Syndromes: From The Laboratory Markers To The Coronary Vessels

    Directory of Open Access Journals (Sweden)

    Palazzuoli Alberto

    2006-01-01

    Full Text Available A number of "interesting" risk markers have been proposed as providing prognostic information in acute coronary syndromes (ACS. Elevation in plasma inflammatory and necrosis biomarkers have been related to future cardiovascular events in individuals with or without prior myocardial infarction. Recently BNP and pro-BNP are entered in clinical practice to recognize patients at major risk, providing incremental information respect to the traditional markers. Together with these laboratory indexes, a few of promising laboratory markers once easily available, could become useful in identification of patients at high risk. Several studies evaluated many markers of platelet aggregation, endothelial dysfunction and vascular thrombosis, but it is not yet clear whether each of the proposed markers may provide incremental predictive information. We describe, following the most studies reported in literature, the laboratory markers with potential clinical and prognostic power that could early help physicians in the identifi cation of patients with impaired coronary disease and more narrowed coronary arteries.

  17. Anticoagulant therapy and outcomes in patients with prior or acute heart failure and acute coronary syndromes: Insights from the APixaban for PRevention of Acute ISchemic Events 2 trial.

    Science.gov (United States)

    Cornel, Jan H; Lopes, Renato D; James, Stefan; Stevens, Susanna R; Neely, Megan L; Liaw, Danny; Miller, Julie; Mohan, Puneet; Amerena, John; Raev, Dimitar; Huo, Yong; Urina-Triana, Miguel; Gallegos Cazorla, Alex; Vinereanu, Dragos; Fridrich, Viliam; Harrington, Robert A; Wallentin, Lars; Alexander, John H

    2015-04-01

    Clinical outcomes and the effects of oral anticoagulants among patients with acute coronary syndrome (ACS) and either a history of or acute heart failure (HF) are largely unknown. We aimed to assess the relationship between prior HF or acute HF complicating an index ACS event and subsequent clinical outcomes and the efficacy and safety of apixaban compared with placebo in these populations. High-risk patients were randomly assigned post-ACS to apixaban 5.0 mg or placebo twice daily. Median follow-up was 8 (4-12) months. The primary outcome was cardiovascular death, myocardial infarction, or stroke. The main safety outcome was thrombolysis in myocardial infarction major bleeding. Heart failure was reported in 2,995 patients (41%), either as prior HF (2,076 [28%]) or acute HF (2,028 [27%]). Patients with HF had a very high baseline risk and were more often managed medically. Heart failure was associated with a higher rate of the primary outcome (prior HF: adjusted hazard ratio [HR] 1.73, 95% CI 1.42-2.10, P acute HF: adjusted HR 1.65, 95% CI 1.35-2.01, P acute HF: adjusted HR 2.52, 95% CI 1.82-3.50). Patients with acute HF also had significantly higher rates of thrombolysis in myocardial infarction major bleeding (prior HF: adjusted HR 1.22, 95% CI 0.65-2.27, P = .54, acute HF: adjusted HR 1.78, 95% CI 1.03-3.08, P = .04). There was no statistical evidence of a differential effect of apixaban on clinical events or bleeding in patients with or without prior HF; however, among patients with acute HF, there were numerically fewer events with apixaban than placebo (14.8 vs 19.3, HR 0.76, 95% CI 0.57-1.01, interaction P = .13), a trend that was not seen in patients with prior HF or no HF. In high-risk patients post-ACS, both prior and acute HFs are associated with an increased risk of subsequent clinical events. Apixaban did not significantly reduce clinical events and increased bleeding in patients with and without HF; however, there was a tendency toward fewer clinical

  18. Effect of treatment for Chlamydia pneumoniae and Helicobacter pylori on markers of inflammation and cardiac events in patients with acute coronary syndromes: South Thames Trial of Antibiotics in Myocardial Infarction and Unstable Angina (STAMINA).

    Science.gov (United States)

    Stone, Adam F M; Mendall, Michael A; Kaski, Juan-Carlos; Edger, Tracey M; Risley, Paul; Poloniecki, Jan; Camm, A John; Northfield, Timothy C

    2002-09-03

    Infection with Helicobacter pylori and Chlamydia pneumoniae is associated with coronary heart disease. We conducted an intervention study using antibiotics against these bacteria in patients with acute coronary syndromes to determine whether antibiotics reduce inflammatory markers and adverse cardiac events. Patients (n=325) admitted with acute myocardial infarction or unstable angina (acute coronary syndromes) were randomized to receive a 1-week course of 1 of 3 treatment regimens: (1) placebo; (2) amoxicillin (500 mg twice daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily); or (3) azithromycin (500 mg once daily), metronidazole (400 mg twice daily), and omeprazole (20 mg twice daily). Serum fibrinogen, white cell count, and high-sensitivity C-reactive protein were measured at study entry and at 1, 3, and 12 months during follow-up. Cardiac death and readmission with acute coronary syndrome were considered clinical end points. Patients were followed for 1 year. C-reactive protein levels were reduced (P=0.03) in unstable angina patients receiving amoxicillin, and fibrinogen was reduced in both patient groups receiving antibiotics (P=0.06). There were 17 cardiac deaths and 71 readmissions with acute coronary syndrome. No difference in frequency or timing of end points was observed between the 2 antibiotic groups. At 12 weeks, there was a 36% reduction in all end points in patients receiving antibiotics compared with placebo (P=0.02). This reduction persisted during the 1-year follow-up. Neither C pneumoniae nor H pylori antibody status was significantly related to response to treatment. Antibiotic treatment significantly reduced adverse cardiac events in patients with acute coronary syndromes, but the effect was independent of H pylori or C pneumoniae seropositivity.

  19. Identification of radiopure titanium for the LZ dark matter experiment and future rare event searches

    Science.gov (United States)

    Akerib, D. S.; Akerlof, C. W.; Akimov, D. Yu.; Alsum, S. K.; Araújo, H. M.; Arnquist, I. J.; Arthurs, M.; Bai, X.; Bailey, A. J.; Balajthy, J.; Balashov, S.; Barry, M. J.; Belle, J.; Beltrame, P.; Benson, T.; Bernard, E. P.; Bernstein, A.; Biesiadzinski, T. P.; Boast, K. E.; Bolozdynya, A.; Boxer, B.; Bramante, R.; Brás, P.; Buckley, J. H.; Bugaev, V. V.; Bunker, R.; Burdin, S.; Busenitz, J. K.; Carels, C.; Carlsmith, D. L.; Carlson, B.; Carmona-Benitez, M. C.; Chan, C.; Cherwinka, J. J.; Chiller, A. A.; Chiller, C.; Cottle, A.; Coughlen, R.; Craddock, W. W.; Currie, A.; Dahl, C. E.; Davison, T. J. R.; Dobi, A.; Dobson, J. E. Y.; Druszkiewicz, E.; Edberg, T. K.; Edwards, W. R.; Emmet, W. T.; Faham, C. H.; Fiorucci, S.; Fruth, T.; Gaitskell, R. J.; Gantos, N. J.; Gehman, V. M.; Gerhard, R. M.; Ghag, C.; Gilchriese, M. G. D.; Gomber, B.; Hall, C. R.; Hans, S.; Hanzel, K.; Haselschwardt, S. J.; Hertel, S. A.; Hillbrand, S.; Hjemfelt, C.; Hoff, M. D.; Holbrook, B.; Holtom, E.; Hoppe, E. W.; Hor, J. Y.-K.; Horn, M.; Huang, D. Q.; Hurteau, T. W.; Ignarra, C. M.; Jacobsen, R. G.; Ji, W.; Kaboth, A.; Kamdin, K.; Kazkaz, K.; Khaitan, D.; Khazov, A.; Khromov, A. V.; Konovalov, A. M.; Korolkova, E. V.; Koyuncu, M.; Kraus, H.; Krebs, H. J.; Kudryavtsev, V. A.; Kumpan, A. V.; Kyre, S.; Lee, C.; Lee, H. S.; Lee, J.; Leonard, D. S.; Leonard, R.; Lesko, K. T.; Levy, C.; Liao, F.-T.; Lin, J.; Lindote, A.; Linehan, R. E.; Lippincott, W. H.; Liu, X.; Lopes, M. I.; Lopez Paredes, B.; Lorenzon, W.; Luitz, S.; Majewski, P.; Manalaysay, A.; Manenti, L.; Mannino, R. L.; Markley, D. J.; Martin, T. J.; Marzioni, M. F.; McConnell, C. T.; McKinsey, D. N.; Mei, D.-M.; Meng, Y.; Miller, E. H.; Mizrachi, E.; Mock, J.; Monzani, M. E.; Morad, J. A.; Mount, B. J.; Murphy, A. St. J.; Nehrkorn, C.; Nelson, H. N.; Neves, F.; Nikkel, J. A.; O'Dell, J.; O'Sullivan, K.; Olcina, I.; Olevitch, M. A.; Oliver-Mallory, K. C.; Palladino, K. J.; Pease, E. K.; Piepke, A.; Powell, S.; Preece, R. M.; Pushkin, K.; Ratcliff, B. N.; Reichenbacher, J.; Reichhart, L.; Rhyne, C. A.; Richards, A.; Rodrigues, J. P.; Rose, H. J.; Rosero, R.; Rossiter, P.; Saba, J. S.; Sarychev, M.; Schnee, R. W.; Schubnell, M.; Scovell, P. R.; Shaw, S.; Shutt, T. A.; Silva, C.; Skarpaas, K.; Skulski, W.; Solmaz, M.; Solovov, V. N.; Sorensen, P.; Sosnovtsev, V. V.; Stancu, I.; Stark, M. R.; Stephenson, S.; Stiegler, T. M.; Stifter, K.; Sumner, T. J.; Szydagis, M.; Taylor, D. J.; Taylor, W. C.; Temples, D.; Terman, P. A.; Thomas, K. J.; Thomson, J. A.; Tiedt, D. R.; Timalsina, M.; To, W. H.; Tomás, A.; Tope, T. E.; Tripathi, M.; Tvrznikova, L.; Va'Vra, J.; Vacheret, A.; van der Grinten, M. G. D.; Verbus, J. R.; Vuosalo, C. O.; Waldron, W. L.; Wang, R.; Watson, R.; Webb, R. C.; Wei, W.-Z.; While, M.; White, D. T.; Whitis, T. J.; Wisniewski, W. J.; Witherell, M. S.; Wolfs, F. L. H.; Woodward, D.; Worm, S.; Xu, J.; Yeh, M.; Yin, J.; Zhang, C.; Lux-Zeplin (LZ) Collaboration

    2017-11-01

    The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a detector containing a total of 10 tonnes of liquid xenon within a double-vessel cryostat. The large mass and proximity of the cryostat to the active detector volume demand the use of material with extremely low intrinsic radioactivity. We report on the radioassay campaign conducted to identify suitable metals, the determination of factors limiting radiopure production, and the selection of titanium for construction of the LZ cryostat and other detector components. This titanium has been measured with activities of 238Ue < 1.6 mBq/kg, 238Ul < 0.09 mBq/kg, 232The = 0.28 ± 0.03 mBq/kg, 232Thl = 0.25 ± 0.02 mBq/kg, 40K < 0.54 mBq/kg, and 60Co < 0.02 mBq/kg (68% CL). Such low intrinsic activities, which are some of the lowest ever reported for titanium, enable its use for future dark matter and other rare event searches. Monte Carlo simulations have been performed to assess the expected background contribution from the LZ cryostat with this radioactivity. In 1,000 days of WIMP search exposure of a 5.6-tonne fiducial mass, the cryostat will contribute only a mean background of 0.160 ± 0.001(stat) ± 0.030(sys) counts.

  20. Assessment of future extreme climate events over the Porto wine Region

    Science.gov (United States)

    Viceto, Carolina; Cardoso, Susana; Marta-Almeida, Martinho; Gorodetskaya, Irina; Rocha, Alfredo

    2017-04-01

    to be produced (Porto and Douro wine), while climate variability affects the annual productivity and quality of the grape harvest. Our study investigates changes in the extreme climate events in the future model runs, through a set of climate change indicators defined by the WRCP's Expert Team in Climate Change Detection and Indices, which uses variables such as daily maximum and minimum temperatures and precipitation amounts. Furthermore, we explore heat waves and their properties (duration, intensity and recovery factor). The analysis shows an increase of the mean temperature in the DDR higher than 2°C by the mid-21st century and 4.5°C by the end of the century, relatively to the reference period. Moreover, we found a major predisposition towards higher values of minimum and maximum daily temperatures and a decrease in the total precipitation during both future periods. These preliminary results indicate increased climatic stress on the DDR wine production and increased vulnerability of the wine varieties in this region.

  1. Non-invasive assessment of coronary calcification

    International Nuclear Information System (INIS)

    Vliegenthart, Rozemarijn; Oei, Hok-Hay S.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jackqueline C. M.

    2004-01-01

    Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to cardiovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for non-invasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research

  2. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  3. Continental-Scale Estimates of Runoff Using Future Climate Storm Events

    Science.gov (United States)

    Recent runoff events have had serious repercussions to both natural ecosystems and human infrastructure. Understanding how shifts in storm event intensities are expected to change runoff responses are valuable for local, regional, and landscape planning. To address this challenge...

  4. Application of a Lifestyle-Based Tool to Estimate Premature Cardiovascular Disease Events in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Gooding, Holly C; Ning, Hongyan; Gillman, Matthew W; Shay, Christina; Allen, Norrina; Goff, David C; Lloyd-Jones, Donald; Chiuve, Stephanie

    2017-09-01

    Few tools exist for assessing the risk for early atherosclerotic cardiovascular disease (ASCVD) events in young adults. To assess the performance of the Healthy Heart Score (HHS), a lifestyle-based tool that estimates ASCVD events in older adults, for ASCVD events occurring before 55 years of age. This prospective cohort study included 4893 US adults aged 18 to 30 years from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent measurement of lifestyle factors from March 25, 1985, through June 7, 1986, and were followed up for a median of 27.1 years (interquartile range, 26.9-27.2 years). Data for this study were analyzed from February 24 through December 12, 2016. The HHS includes age, smoking status, body mass index, alcohol intake, exercise, and a diet score composed of self-reported daily intake of cereal fiber, fruits and/or vegetables, nuts, sugar-sweetened beverages, and red and/or processed meats. The HHS in the CARDIA study was calculated using sex-specific equations produced by its derivation cohorts. The ability of the HHS to assess the 25-year risk for ASCVD (death from coronary heart disease, nonfatal myocardial infarction, and fatal or nonfatal ischemic stroke) in the total sample, in race- and sex-specific subgroups, and in those with and without clinical ASCVD risk factors at baseline. Model discrimination was assessed with the Harrell C statistic; model calibration, with Greenwood-Nam-D'Agostino statistics. The study population of 4893 participants included 2205 men (45.1%) and 2688 women (54.9%) with a mean (SD) age at baseline of 24.8 (3.6) years; 2483 (50.7%) were black; and 427 (8.7%) had at least 1 clinical ASCVD risk factor (hypertension, hyperlipidemia, or diabetes types 1 and 2). Among these participants, 64 premature ASCVD events occurred in women and 99 in men. The HHS showed moderate discrimination for ASCVD risk assessment in this diverse population of mostly healthy young adults (C statistic, 0

  5. [Risk of fatal/non-fatal events in patients with previous coronary heart disease/acute myocardial infarction and treatment with non-steroidal anti-inflammatory drugs].

    Science.gov (United States)

    Muñoz Olmo, L; Juan Armas, J; Gomariz García, J J

    2017-09-04

    Primary Care is the fundamental axis of our health system and obliges us to be consistent with our prescriptions. The non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk and increased risk of all causes of death, as well as acute myocardial infarction (AMI) in patients with a previous myocardial infarction. Pain and cardiac patient management are 2 basic pillars in our daily activity, and we must know the limitations of NSAIDs in patients with established cardiovascular risk. We present a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The objective is to determine the relationship between the consumption of different NSAIDs and the fatal and non-fatal events among patients with known coronary disease. This is a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The literature review was conducted in PubMed search engines like Tripdatabase and with certain keywords. Of the 15 original papers found, 9 did not correspond completely to the central focus, so the approach was decided from 6 original articles from the past 5 years, which address the central focus of increased cardiovascular risk found (fatal and non-fatal events) in patients with prior cardiovascular disease or AMI being prescribed NSAIDs for any reason. The risk of fatal/non-fatal events in each of the studies is expressed by the odds ratio (OR)/hazard ratio (HR), defined as the probability of an event occurring. A moderate risk was observed for ibuprofen. It increases the risk of acute coronary syndrome after 5 years of cardiovascular event, especially in the 2nd year (OR 1.63; 95% CI 1.42-1.87). It also increases the risk of stroke (HR 1.23; 95% IC 1.10-1.38). Cyclo-oxygenase-2 inhibitors were the third risk group, after nabumetone and diclofenac. Celecoxib increases risk from the 14th day of treatment (HR 2.3; 95% CI 1.79-3.02), having an OR

  6. Events

    Directory of Open Access Journals (Sweden)

    Igor V. Karyakin

    2016-02-01

    Full Text Available The 9th ARRCN Symposium 2015 was held during 21st–25th October 2015 at the Novotel Hotel, Chumphon, Thailand, one of the most favored travel destinations in Asia. The 10th ARRCN Symposium 2017 will be held during October 2017 in the Davao, Philippines. International Symposium on the Montagu's Harrier (Circus pygargus «The Montagu's Harrier in Europe. Status. Threats. Protection», organized by the environmental organization «Landesbund für Vogelschutz in Bayern e.V.» (LBV was held on November 20-22, 2015 in Germany. The location of this event was the city of Wurzburg in Bavaria.

  7. Neural correlates of self-appraisals in the near and distant future: an event-related potential study.

    Directory of Open Access Journals (Sweden)

    Yangmei Luo

    Full Text Available To investigate perceptual and neural correlates of future self-appraisals as a function of temporal distance, event-related potentials (ERPs were recorded while participants (11 women, eight men made judgments about the applicability of trait adjectives to their near future selves (i.e., one month from now and their distant future selves (i.e., three years from now. Behavioral results indicated people used fewer positive adjectives, more negative adjectives, recalled more specific events coming to mind and felt more psychologically connected to the near future self than the distant future self. Electrophysiological results demonstrated that negative trait adjectives elicited more positive ERP deflections than did positive trait adjectives in the interval between 550 and 800 ms (late positive component within the near future self condition. However, within the same interval, there were no significant differences between negative and positive traits adjectives in the distant future self condition. The results suggest that negative emotional processing in future self-appraisals is modulated by temporal distance, consistent with predictions of construal level theory.

  8. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Tully, Phillip J; Winefield, Helen R; Baker, Robert A

    2015-01-01

    anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure......BACKGROUND: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical...... and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease. RESULTS: In the total sample, there were 698 cumulative person years of survival for analysis with a median...

  9. Hour glass half full or half empty? Future time perspective and preoccupation with negative events across the life span.

    Science.gov (United States)

    Strough, JoNell; Bruine de Bruin, Wändi; Parker, Andrew M; Lemaster, Philip; Pichayayothin, Nipat; Delaney, Rebecca

    2016-09-01

    According to socioemotional selectivity theory, older adults' emotional well-being stems from having a limited future time perspective that motivates them to maximize well-being in the "here and now." Presumably, then, older adults' time horizons are associated with emotional competencies that boost positive affect and dampen negative affect, but little research has addressed this. Using a U.S. adult life-span sample (N = 3,933; 18-93 years), we found that a 2-factor model of future time perspective (future opportunities; limited time) fit the data better than a 1-factor model. Through middle age, people perceived the life-span hourglass as half full-they focused more on future opportunities than limited time. Around Age 60, the balance changed to increasingly perceiving the life-span hourglass as half empty-they focused less on future opportunities and more on limited time, even after accounting for perceived health, self-reported decision-making ability, and retirement status. At all ages, women's time horizons focused more on future opportunities compared with men's, and men's focused more on limited time. Focusing on future opportunities was associated with reporting less preoccupation with negative events, whereas focusing on limited time was associated with reporting more preoccupation. Older adults reported less preoccupation with negative events, and this association was stronger after controlling for their perceptions of limited time and fewer future opportunities, suggesting that other pathways may explain older adults' reports of their ability to disengage from negative events. Insights gained and questions raised by measuring future time perspective as 2 dimensions are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  10. Treatment of Angina and Microvascular Coronary Dysfunction

    Science.gov (United States)

    Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

    2014-01-01

    Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment

  11. The Relations of Stressful Events and Nonacademic Future Expectations in African American Adolescents: Gender Differences in Parental Monitoring

    Science.gov (United States)

    Cunningham, Michael; Mars, Dustin E.; Burns, Lateela J.

    2012-01-01

    Urban African American high school students (N = 206) completed a study to examine gender differences in parental monitoring and the effect on the relationship between exposure to stressful life events and nonacademic future expectations. Participant's ages range from 13 to 18 (M = 15.78, SD = 1.19). Participants reported high exposure to…

  12. Episodic and semantic components of autobiographical memories and imagined future events in post-traumatic stress disorder.

    Science.gov (United States)

    Brown, Adam D; Addis, Donna Rose; Romano, Tracy A; Marmar, Charles R; Bryant, Richard A; Hirst, William; Schacter, Daniel L

    2014-01-01

    Individuals with post-traumatic stress disorder (PTSD) tend to retrieve autobiographical memories with less episodic specificity, referred to as overgeneralised autobiographical memory. In line with evidence that autobiographical memory overlaps with one's capacity to imagine the future, recent work has also shown that individuals with PTSD also imagine themselves in the future with less episodic specificity. To date most studies quantify episodic specificity by the presence of a distinct event. However, this method does not distinguish between the numbers of internal (episodic) and external (semantic) details, which can provide additional insights into remembering the past and imagining the future. This study employed the Autobiographical Interview (AI) coding scheme to the autobiographical memory and imagined future event narratives generated by combat veterans with and without PTSD. Responses were coded for the number of internal and external details. Compared to combat veterans without PTSD, those with PTSD generated more external than internal details when recalling past or imagining future events, and fewer internal details were associated with greater symptom severity. The potential mechanisms underlying these bidirectional deficits and clinical implications are discussed.

  13. Long-term risk of recurrent vascular events after young stroke: The FUTURE study

    NARCIS (Netherlands)

    Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Vlugt, M.J. van der; Dijk, E.J. van; Leeuw, F.E. de

    2013-01-01

    OBJECTIVE: Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke. METHODS: We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA),

  14. Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years......), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early- onset CAD were recruited from the Western Denmark Heart...... Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88...

  15. Short-term effects of air pollution, markers of endothelial activation, and coagulation to predict major adverse cardiovascular events in patients with acute coronary syndrome: insights from AIRACOS study.

    Science.gov (United States)

    Dominguez-Rodriguez, Alberto; Abreu-Gonzalez, Pedro; Rodríguez, Sergio; Avanzas, Pablo; Juarez-Prera, Ruben A

    2017-07-01

    The aim of this study was to determine whether markers of inflammation and coagulation are associated with short-term particulate matter exposure and predict major adverse cardiovascular events at 360 d in patients with acute coronary syndrome (ACS). We included 307 consecutive patients, and assessed the average concentrations of data on atmospheric pollution in ambient air and meteorological variables from 1 d up to 7 d prior to admission. In patients with ACS, the markers of endothelial activation and coagulation, but not black carbon exposure, are associated with major adverse cardiovascular events at one-year follow-up.

  16. GC Side Event: Future of Nuclear Energy: Engaging the Young Generation. Presentations

    International Nuclear Information System (INIS)

    2017-01-01

    This event presented the IAEA’s programmes for the education and training of a new generation of nuclear professionals. It also featured the annual European Master of Science in Nuclear Engineering (EMSNE) award ceremony

  17. Contribution of Genetic Background, Traditional Risk Factors, and HIV-Related Factors to Coronary Artery Disease Events in HIV-Positive Persons

    Science.gov (United States)

    Rotger, Margalida; Glass, Tracy R.; Junier, Thomas; Lundgren, Jens; Neaton, James D.; Poloni, Estella S.; van 't Wout, Angélique B.; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F.; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A.; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P.; Li, Xiuhong; Kingsley, Lawrence A.; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S.; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M.; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; De Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H.; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; De Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R.; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A.; Reiss, Peter; Weber, Rainer; Bucher, Heiner C.; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E.

    2013-01-01

    Background Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. Methods In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. Results A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9×10−4). In the final multivariable model, participants with an unfavorable genetic background (top genetic score quartile) had a CAD odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.05–2.04). This effect was similar to hypertension (OR = 1.36; 95% CI, 1.06–1.73), hypercholesterolemia (OR = 1.51; 95% CI, 1.16–1.96), diabetes (OR = 1.66; 95% CI, 1.10–2.49), ≥1 year lopinavir exposure (OR = 1.36; 95% CI, 1.06–1.73), and current abacavir treatment (OR = 1.56; 95% CI, 1.17–2.07). The effect of the genetic risk score was additive to the effect of nongenetic CAD risk factors, and did not change after adjustment for family history of CAD. Conclusions In the setting of HIV infection, the effect of an unfavorable genetic background was similar to traditional CAD risk factors and certain adverse antiretroviral exposures. Genetic testing may provide prognostic information complementary to family history of CAD. PMID:23532479

  18. The current and future impacts of the 2007-2009 economic recession on the festival and event industry

    OpenAIRE

    Goldblatt, Joe J; Lee, Seung-won

    2012-01-01

    Purpose – The purpose of this paper is to analyze and understand the impact of the global financial\\ud crisis during 2007-2009. Furthermore, the paper seeks to identiy critical impacts upon the festival and\\ud event industry as a result of this crisis and to identify strategies to help members of the industry\\ud positively advance in the future.\\ud Design/methodology/approach – Festival and event industry professionals were surveyed\\ud electronically about their business performance during th...

  19. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Pauly John M

    2008-04-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM. Results We consecutively studied 86 patients with ICM (LVEF Conclusion Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.

  20. High temporal discounters overvalue immediate rewards rather than undervalue future rewards: an event-related brain potential study.

    Science.gov (United States)

    Cherniawsky, Avital S; Holroyd, Clay B

    2013-03-01

    Impulsivity is characterized in part by heightened sensitivity to immediate relative to future rewards. Although previous research has suggested that "high discounters" in intertemporal choice tasks tend to prefer immediate over future rewards because they devalue the latter, it remains possible that they instead overvalue immediate rewards. To investigate this question, we recorded the reward positivity, a component of the event-related brain potential (ERP) associated with reward processing, with participants engaged in a task in which they received both immediate and future rewards and nonrewards. The participants also completed a temporal discounting task without ERP recording. We found that immediate but not future rewards elicited the reward positivity. High discounters also produced larger reward positivities to immediate rewards than did low discounters, indicating that high discounters relatively overvalued immediate rewards. These findings suggest that high discounters may be more motivated than low discounters to work for monetary rewards, irrespective of the time of arrival of the incentives.

  1. Urinary Vitamin D Binding Protein and KIM-1 Are Potent New Biomarkers of Major Adverse Renal Events in Patients Undergoing Coronary Angiography.

    Directory of Open Access Journals (Sweden)

    Lyubov Chaykovska

    Full Text Available Vitamin-D-binding protein (VDBP is a low molecular weight protein that is filtered through the glomerulus as a 25-(OH vitamin D 3/VDBP complex. In the normal kidney VDBP is reabsorbed and catabolized by proximal tubule epithelial cells reducing the urinary excretion to trace amounts. Acute tubular injury is expected to result in urinary VDBP loss. The purpose of our study was to explore the potential role of urinary VDBP as a biomarker of an acute renal damage.We included 314 patients with diabetes mellitus or mild renal impairment undergoing coronary angiography and collected blood and urine before and 24 hours after the CM application. Patients were followed for 90 days for the composite endpoint major adverse renal events (MARE: need for dialysis, doubling of serum creatinine after 90 days, unplanned emergency rehospitalization or death.Increased urine VDBP concentration 24 hours after contrast media exposure was predictive for dialysis need (no dialysis: 113.06 ± 299.61 ng/ml, n = 303; need for dialysis: 613.07 ± 700.45 ng/ml, n = 11, Mean ± SD, p<0.001, death (no death during follow-up: 121.41 ± 324.45 ng/ml, n = 306; death during follow-up: 522.01 ± 521.86 ng/ml, n = 8; Mean ± SD, p<0.003 and MARE (no MARE: 112.08 ± 302.00 ng/ml, n = 298; MARE: 506.16 ± 624.61 ng/ml, n = 16, Mean ± SD, p<0.001 during the follow-up of 90 days after contrast media exposure. Correction of urine VDBP concentrations for creatinine excretion confirmed its predictive value and was consistent with increased levels of urinary Kidney Injury Molecule-1 (KIM-1 and baseline plasma creatinine in patients with above mentioned complications. The impact of urinary VDBP and KIM-1 on MARE was independent of known CIN risk factors such as anemia, preexisting renal failure, preexisting heart failure, and diabetes.Urinary VDBP is a promising novel biomarker of major contrast induced nephropathy-associated events 90 days after contrast media exposure.

  2. Effects of continuous positive airway pressure on anxiety, depression, and major cardiac and cerebro-vascular events in obstructive sleep apnea patients with and without coronary artery disease.

    Science.gov (United States)

    Lee, Ming-Chung; Shen, Yu-Chih; Wang, Ji-Hung; Li, Yu-Ying; Li, Tzu-Hsien; Chang, En-Ting; Wang, Hsiu-Mei

    2017-01-01

    Obstructive sleep apnea (OSA) is associated with bad cardiovascular outcomes and a high prevalence of anxiety and depression. This study investigated the effects of continuous positive airway pressure (CPAP) on the severity of anxiety and depression in OSA patients with or without coronary artery disease (CAD) and on the rate of cardio- and cerebro-vascular events in those with OSA and CAD. This prospective study included patients with moderate-to-severe OSA, with or without a recent diagnosis of CAD; all were started on CPAP therapy. Patients completed the Chinese versions of the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline and after 6-month follow-up. The occurrence of major adverse cardiac and cerebrovascular events (MACCE) was assessed every 3 months up to 1 year. BAI scores decreased from 8.5 ± 8.4 at baseline to 5.4 ± 6.9 at 6 months in CPAP-compliant OSA patients without CAD ( P < 0.05). BAI scores also decreased from 20.7 ± 14.9 to 16.1 ± 14.5 in CPAP-compliant OSA patients with CAD. BDI-II scores decreased in CPAP-compliant OSA patients without CAD (from 11.1 ± 10.7 at baseline to 6.6 ± 9.5 at 6 months) and in CPAP-compliant OSA patients with CAD (from 20.4 ± 14.3 to 15.9 ± 7.3). In addition, there was a large effect size (ES) of BAI and BDI in 6-month CPAP treatment of OSA patients with CAD and a large ES in those with OSA under CPAP treatment. In OSA patients with CAD, the occurrence of MACCE was significantly lower in CPAP-compliant patients than that in CPAP noncompliant patients (11% in CPAP compliant and 50% in noncompliant; P < 0.05). CPAP improved anxiety and depression in OSA patients regardless of CAD. In OSA patients with CAD, CPAP-compliant patients had a lower 1-year rate of MACCE than CPAP-noncompliant patients.

  3. Solar Energetic Particle Event Risks for Future Human Missions within the Inner Heliosphere

    Science.gov (United States)

    Over, S.; Ford, J.

    2017-12-01

    As astronauts travel beyond low-Earth orbit (LEO), space weather research will play a key role in determining risks from space radiation. Of interest are the rare, large solar energetic particle (SEP) events that can cause significant medical effects during flight. Historical SEP data were analyzed from the Geostationary Operational Environmental Satellites (GOES) program covering the time period of 1986 to 2016 for SEP events. The SEP event data were combined with a Monte Carlo approach to develop a risk model to determine maximum expected doses for missions within the inner heliosphere. Presented here are results from risk assessments for proposed Mars transits as compared to a geostationary Earth-bound mission. Overall, the greatest risk was for the return from Mars with a Venus swing-by, due to the additional transit length and decreased distance from the Sun as compared to traditional Hohmann transfers. The overall results do not indicate that the effects of SEP events alone would prohibit these missions based on current radiation limits alone, but the combination of doses from SEP events and galactic cosmic radiation may be significant, and should be considered in all phases of mission design.

  4. How Repeated Time To Event (RTTE) modelling of opioid requests after surgery may improve future post-operative pain management

    DEFF Research Database (Denmark)

    Juul, Rasmus Vestergaard; Rasmussen, Sten; Kreilgaard, Mads

    at Orthopaedic Department, Aalborg University Hospital, Denmark during the period May-Dec 2012. Morphine administration times (estimated precision: ±5mins), formulations and doses were extracted from medical journals in the hospitalization period or until 96 hours after surgery. RTTE modelling was performed......Title: How Repeated Time To Event (RTTE) modelling of opioid requests after surgery may improve future post-operative pain management Author: Rasmus Vestergaard Juul (1) Sten Rasmussen (2) Mads Kreilgaard (1) Ulrika S. H. Simonsson (3) Lona Louring Christrup (1) Trine Meldgaard Lund (1) Institution...... of surgery specific, drug concentration related, population specific and/or time-varying covariates of opioid requests and pain events. Conclusions: A framework has been developed based on RTTE modelling that may help improve future pain management by 1) Identification of surgery specific patterns in pain...

  5. Detection and severity of coronary disease: comparison between Framingham and calcium scores using multi-slice tomography

    International Nuclear Information System (INIS)

    Rodriguez Gomez, Maria Liliana; Montenegro, Edison; Ruiz, Angela Maria; Ardila, Jaime

    2011-01-01

    Introduction: multiple studies have shown that the coronary calcium index is an independent, more accurate predictor of future coronary events in relation to traditional risk factors. However, these studies have not been conducted in populations of developing countries like Colombia. Objective: to compare the strength of association between the Framingham index and the coronary calcium score in detecting the presence and severity of coronary disease as defined by 64-channel multi-slice angio-CT in order to provide additional information for decision-making in our asymptomatic coronary population. Methodology: we reviewed the written reports of coronary angiography scans performed in past 3 years. Based on this information, bivariate (calculation of Spearman rho correlation coefficients) and multivariate (logistic regression) analyses were performed. Results: the coronary calcium score showed a higher correlation with the presence and severity of coronary disease, Spearman Rho coefficient, compared with the Framingham index, Spearman's Rho coefficient of 0.30 (p<0.001). The moderate Framingham index (10-19%) shows no strength of association with significant and non-significant coronary artery disease, OR = 2, 51 CI 95% (0.7-8.9) and OR = 2.3 CI 95% (0.86-6.15), respectively. Patients with calcium values = 100 showed significant strength of association, OR = 182, 95% (17.4 -190.2), with significant coronary disease compared with high Framingham index values (=20%), OR = 18.6, CI 95% (1.75-198). Conclusions: the coronary calcium score has a higher correlation with the presence and severity of coronary disease when compared with the Framingham index. There is a low correlation between the index and Framingham coronary calcium.

  6. Modern antiplatelet agents in coronary artery disease.

    LENUS (Irish Health Repository)

    Power, Rachel F

    2012-10-01

    Dual antiplatelet therapy is well recognized in the prevention of thrombotic complications of acute coronary syndrome and percutaneous coronary interventions. Despite clinical benefits of aspirin and clopidogrel therapy, a number of limitations curtail their efficacy: slow onset of action, variability in platelet inhibitory response and potential drug-drug interactions. Furthermore, the single platelet-activation pathway targeted by these agents allows continued platelet activation via other pathways, ensuring incomplete protection against ischemic events, thus, underscoring the need for alternate antiplatelet treatment strategies. A number of novel antiplatelet agents are currently in advance development and many have established superior effects on platelet inhibition, clinical outcomes and safety profile than clopidogrel in high-risk patients. The aim of this review is to provide an overview of the current status of P2Y12 receptor inhibition and PAR-1 antagonists in determining a future strategy for individualized antiplatelet therapy.

  7. The future of mega sport events : Examining the ‘Dutch Approach’ to legacy planning

    NARCIS (Netherlands)

    Hartman, S.; Zandberg, T.

    2015-01-01

    Purpose – Mega sport events (MSE) are immensely popular but also highly criticized because these nclude large public budgets and involve politically sensitive topics. In this context, there is an increasing attention toward legacy planning, the effort to confer long-term benefits to a host

  8. Event generation and production of signal inputs for the search of dark matter mediator signal at a future hadron collider

    CERN Document Server

    Chalise, Darshan

    2017-01-01

    The interaction between Dark Matter particles and Standard Model particles is possible through a force mediated by a Dark Matter(DM) - Standard Model(SM) mediator. If that mediator decays through a dijet event, the reconstructed invariant mass of the jets will peak at a specific value, in contrast to the smooth QCD background. This analysis is a preliminary work towards the understanding of how changes in detector conditions at the Future Circular Collider affect the sensitivity of the mediator signal. MadGraph 5 was used to produce events with 30 TeV DM mediator and Heppy was used to produce flat n-tuples for ROOT analysis. MadAnalysis 5 was then used to produce histograms of MadGraph events and PyRoot was used to analyze Heppy output. Histograms of invariant mass of the jets after event production through MadGraph as well as after Heppy analysis showed a peak at 30 TeV. This verified the production of a 30 TeV mediator during event production.

  9. SLOW SLIP EVENTS: PARAMETERS, CONDITIONS OF OCCURRENCE, AND FUTURE RESEARCH PROSPECTS

    Directory of Open Access Journals (Sweden)

    G. G. Kocharyan

    2014-01-01

    Full Text Available Slow slip events along faults and fractures are reviewed. Such inter-block displacements can be recorded at various scale levels and considered as transitional from quasi-stable (creep to dynamic slip (earthquake. Such events include seismogenic slip along faults at velocities by one to three orders lower than those in case of 'normal' earthquakes, as well as aseismic slip cases. Discovering such events facilitates better understanding of how energy accumulated during deformation of the crust is released.Studying conditions and the evolution of transitional regimes can provide new important information on the structure and regularities of deformation in fault zones.Data from latest publications by different authors are consolidated, and the data analysis results are presented. Over 170 slow slip events are reviewed. Based on the consolidated data and modelling results obtained by the authors, relationships between parameters of the reviewed process are established, scale relations between the events are considered, and a first-approximation analysis is conducted for impacts of geomaterial characteristics on various deformation regimes.Low-frequency earthquake foci and slow slip sites are most typically located in zones of transition from stable creep areas to seismogenic segments of the discontinuity (Fig. 3 It can be logically supposed that in such transitional zones, the interface has specific frictional properties providing for a regime that can be termed as 'conditionally stable slip'.The duration of slow deformation events is roughly proportional to the released seismic moment, while such a ratio is close to self-similarity in case of 'normal' earthquakes (Fig. 4. In case of slow slip, an area of the displaced section is larger by many factors than the corresponding value for an earthquake with the same seismic moment, while an average displacement amplitude along the fault is significantly smaller (Figures 5 and 6. Velocities of slip

  10. The association of incidentally detected heart valve calcification with future cardiovascular events

    OpenAIRE

    Gondrie, Martijn J. A.; van der Graaf, Yolanda; Jacobs, Peter C.; Oen, Ay L.; Mali, Willem P. Th. M.

    2010-01-01

    Objectives This study aims to investigate the prognostic value of incidental aortic valve calcification (AVC), mitral valve calcification (MVC) and mitral annular calcification (MAC) for cardiovascular events and non-rheumatic valve disease in particular on routine diagnostic chest CT. Methods The study followed a case-cohort design. 10410 patients undergoing chest CT were followed for a median period of 17 months. Patients referred for cardiovascular disease were excluded. A random sample of...

  11. Discrete event simulation and virtual reality use in industry: new opportunities and future trends

    OpenAIRE

    Turner, Christopher; Hutabarat, Windo; Oyekan, John; Tiwari, Ashutosh

    2016-01-01

    This paper reviews the area of combined discrete event simulation (DES) and virtual reality (VR) use within industry. While establishing a state of the art for progress in this area, this paper makes the case for VR DES as the vehicle of choice for complex data analysis through interactive simulation models, highlighting both its advantages and current limitations. This paper reviews active research topics such as VR and DES real-time integration, communication protocols,...

  12. Future extreme events in European climate: An exploration of regional climate model projections

    DEFF Research Database (Denmark)

    Beniston, M.; Stephenson, D.B.; Christensen, O.B.

    2007-01-01

    -90) and future (2071-2 100) climate on the basis of regional climate model simulations produced by the PRUDENCE project. A summary of the main results follows. Heat waves - Regional surface warming causes the frequency, intensity and duration of heat waves to increase over Europe. By the end of the twenty first...

  13. Montana Proficiency Events Handbook. FHA HERO: Future Homemakers of America toward New Horizons.

    Science.gov (United States)

    McGregor, Linda, Ed.; Quickenden, Sandy, Ed.

    This handbook contains directions for FHA/HERO (Future Homemakers of America/Home Economics Related Occupations) participation activities in Montana. Participation activities are local, state, and national level competitions involving students in vocational home economics programs. The handbook provides a general overview of participation…

  14. Motivated encoding selectively promotes memory for future inconsequential semantically-related events.

    Science.gov (United States)

    Oyarzún, Javiera P; Packard, Pau A; de Diego-Balaguer, Ruth; Fuentemilla, Lluis

    2016-09-01

    Neurobiological models of long-term memory explain how memory for inconsequential events fades, unless these happen before or after other relevant (i.e., rewarding or aversive) or novel events. Recently, it has been shown in humans that retrospective and prospective memories are selectively enhanced if semantically related events are paired with aversive stimuli. However, it remains unclear whether motivating stimuli, as opposed to aversive, have the same effect in humans. Here, participants performed a three phase incidental encoding task where one semantic category was rewarded during the second phase. A memory test 24h after, but not immediately after encoding, revealed that memory for inconsequential items was selectively enhanced only if items from the same category had been previously, but not subsequently, paired with rewards. This result suggests that prospective memory enhancement of reward-related information requires, like previously reported for aversive memories, of a period of memory consolidation. The current findings provide the first empirical evidence in humans that the effects of motivated encoding are selectively and prospectively prolonged over time. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The clinical utility of lipid profile and positive troponin in predicting future cardiac events

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2012-02-01

    Full Text Available Objective: To study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive troponin I (TnI test. Methods: In this retrospective study data of the 740 patients presented to the emergency department with symptoms of cardiac ischemia that underwent both troponin and lipid profiles tests were compared with the lipid profiles of 411 normal healthy subjects (controls. The troponin was detected qualitatively when a specimen contains TnI above the 99th percentile (TnI >0.5 ng/ mL. The total cholesterol (TC, high density lipoproteins (HDL, very low density lipoproteins (VLDL, and triacyl glycerol (TG levels were also analyzed and low density lipoprotein level (LDL was calculated using Friedewald ’s formula. Results: Patients with chest pain and positive troponin test (with confirmed cardiac event were found to have significantly elevated levels of TC, TG, LDL and significantly reduced HDL levels when compared to the patients who experienced only chest pain (negative troponin and healthy controls. Conclusions: Traditional lipid profile levels still can be used in screening populations to identify the subjects with high risk of developing cardiac event which is identified by highly sensitive and specific positive troponin test.

  16. Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction

    International Nuclear Information System (INIS)

    Leppo, J.A.; O'Brien, J.; Rothendler, J.A.; Getchell, J.D.; Lee, V.W.

    1984-01-01

    To evaluate the safety and usefulness of serial thallium scanning immediately after intravenous dipyridamole, we studied 51 patients recovering from acute myocardial infarction. Eight patients experienced angina during the procedure, but there were no serious complications. Patients were followed for a mean period of 19 months after hospital discharge. Eleven of 12 patients who died during follow-up or had another infarction had shown transient defects (redistribution) on their predischarge scan, as had 22 of the 24 patients who needed readmission for management of angina. Among all the other clinical or scintigraphic criteria tested, the presence of redistribution on the dipyridamole-thallium scan was the only significant predictor of these serious cardiac events. Twenty-six patients were also given a submaximal exercise test before discharge, of whom 13 subsequently had serious cardiac events. The exercise test had been positive in only 6 of these 13 patients, whereas the dipyridamole-thallium scan had shown a redistribution pattern in 12 (P less than 0.001). We conclude from this preliminary study that dipyridamole-thallium scintigraphy after myocardial infraction is relatively safe. It appears to be a more sensitive predictor of subsequent cardiac events than a submaximal exercise test and may therefore prove useful in evaluating patients after recovery from a myocardial infarction

  17. MODELS OF MAJOR ADVERSE CARDIAC EVENT RISK USING RESULTS OF EXERCISE STRESS ECHOCARDIOGRAPHY WITH NONINVASIVE CORONARY ARTERY FLOW ASSESSMENT IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    A. V. Zagatina

    2017-01-01

    Full Text Available Ultrasound non-invasive coronary artery imaging contributes to the diagnosis of ischemic heart disease (IHD in clinical practice. However, data of the prognostic value obtained from a complex analysis of contractility disorders and coronary blood flow parameters during exercise tests in the world literature are still not available. Aim. To develop risk models for adverse outcomes in patients with probable or definite IHD based on the results of a stress test with a noninvasive coronary blood flow study. Material and methods. Medical data of 689 patients with probable or definite IHD who underwent stress echocardiography with satisfactory visualization of the anterior interventricular artery (AIVA were included in the analysis. All patients had stress echocardiography on a horizontal bicycle ergometer. Registration of coronary blood flow in the middle third of the AIVA was performed at rest and at the peak of the load with calculation of the coronary reserve value. Further patient follow-up lasted 3 years. Models of further negative outcomes were developed on the basis of the stress echocardiography results and of coronary blood flow parameters. Results. Three models that take into account the factors associated with further mortality, mortality/myocardial infarction and sum of negative outcomes were developed in the study. These models divide a cohort of patients with probable or definite IHD into groups of low, medium and very high risks. Factors associated with the risk of death include: age >56 years, load power <100 W, breach of contractility in the blood supply zone of the circumflex artery initially and during exercise, the difference in blood flow velocities in the AIVA<10 cm/s, coronary reserve of AIVA<2. The risk model of death, taking into account these factors, suggests dividing patients into low-risk group if there are ≤2 factors (mortality 0.6% for 3 years, medium risk – from 2 to 4 factors (mortality 1.8%, high risk – ≥5

  18. A Simple Ensemble Simulation Technique for Assessment of Future Variations in Specific High-Impact Weather Events

    Science.gov (United States)

    Taniguchi, Kenji

    2018-04-01

    To investigate future variations in high-impact weather events, numerous samples are required. For the detailed assessment in a specific region, a high spatial resolution is also required. A simple ensemble simulation technique is proposed in this paper. In the proposed technique, new ensemble members were generated from one basic state vector and two perturbation vectors, which were obtained by lagged average forecasting simulations. Sensitivity experiments with different numbers of ensemble members, different simulation lengths, and different perturbation magnitudes were performed. Experimental application to a global warming study was also implemented for a typhoon event. Ensemble-mean results and ensemble spreads of total precipitation, atmospheric conditions showed similar characteristics across the sensitivity experiments. The frequencies of the maximum total and hourly precipitation also showed similar distributions. These results indicate the robustness of the proposed technique. On the other hand, considerable ensemble spread was found in each ensemble experiment. In addition, the results of the application to a global warming study showed possible variations in the future. These results indicate that the proposed technique is useful for investigating various meteorological phenomena and the impacts of global warming. The results of the ensemble simulations also enable the stochastic evaluation of differences in high-impact weather events. In addition, the impacts of a spectral nudging technique were also examined. The tracks of a typhoon were quite different between cases with and without spectral nudging; however, the ranges of the tracks among ensemble members were comparable. It indicates that spectral nudging does not necessarily suppress ensemble spread.

  19. Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

    Science.gov (United States)

    Pandor, Abdullah; Pollard, Daniel; Chico, Tim; Henderson, Robert; Stevenson, Matt

    2016-05-01

    As part of its Single Technology Appraisal process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures rivaroxaban (Xarelto, Bayer) to submit evidence of the clinical and cost effectiveness of rivaroxaban for the prevention of adverse outcomes in patients after the acute management of acute coronary syndrome (ACS). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from a randomised, double-blind, phase III, placebo-controlled trial of rivaroxaban (either 2.5 or 5 mg twice daily) in patients with recent ACS [unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI)]. In addition, all patients received antiplatelet therapy [aspirin alone or aspirin and a thienopyridine either as clopidogrel (approximately 99 %) or ticlopidine (approximately 1 %) according to national or local guidelines]. The higher dose of rivaroxaban (5 mg twice daily) did not form part of the marketing authorisation. A post hoc subgroup analysis of the licensed patients who had ACS with elevated cardiac biomarkers (that is, patients with STEMI and NSTEMI) without prior stroke or transient ischaemic stroke showed that compared with standard care, the addition of rivaroxaban (2.5 mg twice daily) to existing antiplatelet therapy reduced the composite endpoint of cardiovascular mortality, myocardial infarction or stroke, but increased the risk of major bleeding and intracranial haemorrhage. However, there were a number of limitations in the evidence base that warrant caution in its interpretation. In particular, the evidence may be confounded because of the post hoc subgroup

  20. Not all past events are equal: biased attention and emerging heuristics in children's past-to-future forecasting.

    Science.gov (United States)

    Lagattuta, Kristin Hansen; Sayfan, Liat

    2013-01-01

    Four- to 10-year-olds and adults (N = 265) responded to eight scenarios presented on an eye tracker. Each trial involved a character who encounters a perpetrator who had previously enacted positive (P), negative (N), or both types of actions toward him or her in varying sequences (NN, PP, PN, and NP). Participants predicted the character's thoughts about the likelihood of future events, emotion type and intensity, and decision to approach or avoid. All ages made more positive forecasts for PP > NP > PN > NN trials, with differentiation by past experience widening with age. Age-related increases in weighting the most recent past event also appeared in eye gaze. Individual differences in biased visual attention correlated with verbal judgments. Findings contribute to research on risk assessment, person perception, and heuristics in judgment and decision making. © 2013 The Authors. Child Development © 2013 Society for Research in Child Development, Inc.

  1. Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons

    NARCIS (Netherlands)

    Rotger, Margalida; Glass, Tracy R; Junier, Thomas; Lundgren, Jens; Neaton, James D; Poloni, Estella S; van 't Wout, Angélique B; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P; Li, Xiuhong; Kingsley, Lawrence A; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; De Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; De Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A; Reiss, Peter; Weber, Rainer; Bucher, Heiner C; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E; Schölvinck, Elisabeth H.

    BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the

  2. Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons

    NARCIS (Netherlands)

    Rotger, Margalida; Glass, Tracy R.; Junier, Thomas; Lundgren, Jens; Neaton, James D.; Poloni, Estella S.; van 't Wout, Angélique B.; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F.; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A.; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P.; Li, Xiuhong; Kingsley, Lawrence A.; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S.; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M.; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; de Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H.; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; de Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R.; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A.; Reiss, Peter; Weber, Rainer; Bucher, Heiner C.; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E.; Gras, A. Luuk; van Wout, Angelique B.; Arnedo-Valero, Mireia; Sierra, Mariana de Paz; Rodriguez, Ana Torrecilla; Garcia, Juan Gonzalez; Arribas, Jose R.; Aubert, V.; Barth, J.; Battegay, M.; Bernasconi, E.; Böni, J.; Bucher, H. C.; Burton-Jeangros, C.; Calmy, A.; Cavassini, M.; Egger, M.; Elzi, L.; Fehr, J.; Fellay, J.; Francioli, P.; Furrer, H.; Fux, C. A.; Gorgievski, M.; Günthard, H.; Haerry, D.; Hasse, B.; Hirsch, H. H.; Hirschel, B.; Hösli, I.; Kahlert, C.; Kaiser, L.; Keiser, O.; Kind, C.; Klimkait, T.; Kovari, H.; Ledergerber, B.; Martinetti, G.; Martinez de Tejada, B.; Metzner, K.; Müller, N.; Nadal, D.; Pantaleo, G.; Rauch, A.; Regenass, S.; Rickenbach, M.; Rudin, C.; Schmid, P.; Schultze, D.; Schöni-Affolter, F.; Schüpbach, J.; Speck, R.; Taffé, P.; Tarr, P.; Telenti, A.; Trkola, A.; Vernazza, P.; Weber, R.; Prins, Yerly S. J. M.; Kuijpers, T. W.; Scherpbier, H. J.; Boer, K.; van der Meer, J. T. M.; Wit, F. W. M. N.; Godfried, M. H.; van der Poll, T.; Nellen, F. J. B.; Lange, J. M. A.; Geerlings, S. E.; van Vugt, M.; Vrouenraets, S. M. E.; Pajkrt, D.; Bos, J. C.; van der Valk, M.; Schreij, G.; Lowe, S.; Oude Lashof, A.; Pronk, M. J. H.; Bravenboer, B.; van der Ende, M. E.; de Vries-Sluijs, T. E. M. S.; Schurink, C. A. M.; van der Feltz, M.; Nouwen, J. L.; Gelinck, L. B. S.; Verbon, A.; Rijnders, B. J. A.; van de Ven-de Ruiter, E. D.; Slobbe, L.; Haag, Den; Kauffmann, R. H.; Schippers, E. F.; Groeneveld, P. H. P.; Alleman, M. A.; Bouwhuis, J. W.; ten Kate, R. W.; Soetekouw, R.; Kroon, F. P.; van den Broek, P. J.; van Dissel, J. T.; Arend, S. M.; van Nieuwkoop, C.; de Boer, M. J. G.; Jolink, H.; den Hollander, J. G.; Pogany, K.; Bronsveld, W.; Kortmann, W.; van Twillert, G.; van Houte, D. P. F.; Polée, M. B.; van Vonderen, M. G. A.; ten Napel, C. H. H.; Kootstra, G. J.; Brinkman, K.; Blok, W. L.; Frissen, P. H. J.; Schouten, W. E. M.; van den Berk, G. E. L.; Juttmann, J. R.; van Kasteren, M. E. E.; Brouwer, A. E.; Mulder, J. W.; van Gorp, E. C. M.; Smit, P. M.; Weijer, S.; van Eeden, A.; Verhagen, D. W. M.; Sprenger, H. G.; Doedens, R.; Scholvinck, E. H.; van Assen, S.; Stek, C. J.; Hoepelman, I. M.; Mudrikova, T.; Schneider, M. M. E.; Jaspers, C. A. J. J.; Ellerbroek, P. M.; Peters, E. J. G.; Maarschalk-Ellerbroek, L. J.; Oosterheert, J. J.; Arends, J. E.; Wassenberg, M. W. M.; van der Hilst, J. C. H.; Richter, C.; van der Berg, J. P.; Gisolf, E. H.; Margolick, Joseph B.; Plankey, Michael; Crain, Barbara; Dobs, Adrian; Farzadegan, Homayoon; Gallant, Joel; Johnson-Hill, Lisette; Sacktor, Ned; Selnes, Ola; Shepard, James; Thio, Chloe; Phair, John P.; Wolinsky, Steven M.; Badri, Sheila; Conover, Craig; O'Gorman, Maurice; Ostrow, David; Palella, Frank; Ragin, Ann; Detels, Roger; Martínez-Maza, Otoniel; Aronow, Aaron; Bolan, Robert; Breen, Elizabeth; Butch, Anthony; Fahey, John; Jamieson, Beth; Miller, Eric N.; Oishi, John; Vinters, Harry; Visscher, Barbara R.; Wiley, Dorothy; Witt, Mallory; Yang, Otto; Young, Stephen; Zhang, Zuo Feng; Rinaldo, Charles R.; Becker, James T.; Cranston, Ross D.; Martinson, Jeremy J.; Mellors, John W.; Silvestre, Anthony J.; Stall, Ronald D.; Muñoz, Alvaro; Abraham, Alison; Althoff, Keri; Cox, Christopher; D'Souza, Gypsyamber; Gange, Stephen J.; Golub, Elizabeth; Schollenberger, Janet; Seaberg, Eric C.; Su, Sol; Huebner, Robin E.; Dominguez, Geraldina; Moroni, M.; Angarano, G.; Antinori, A.; Carosi, G.; Cauda, R.; Monforte, A. d'Arminio; Di Perri, G.; Galli, M.; Iardino, R.; Ippolito, G.; Lazzarin, A.; Perno, C. F.; Sagnelli, E.; Viale, P. L.; Von Schlosser, F.; d'Arminio Monforte, A.; Ammassari, A.; Andreoni, M.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, M. R.; Castagna, A.; Ceccherini-Silberstein, F.; Cozzi-Lepri, A.; de Luca, A.; Gargiulo, M.; Gervasoni, C.; Girardi, E.; Lichtner, M.; Lo Caputo, S.; Madeddu, G.; Maggiolo, F.; Marcotullio, S.; Monno, L.; Murri, R.; Mussini, C.; Puoti, M.; Torti, C.; Fanti, I.; Formenti, T.; Galli, Laura; Lorenzini, Patrizia; Montroni, M.; Giacometti, A.; Costantini, A.; Riva, A.; Tirelli, U.; Martellotta, F.; Ladisa, N.; Lazzari, G.; Verucchi, G.; Castelli, F.; Scalzini, A.; Minardi, C.; Bertelli, D.; Quirino, T.; Abeli, C.; Manconi, P. E.; Piano, P.; Vecchiet, J.; Falasca, K.; Carnevale, G.; Lorenzotti, S.; Sighinolfi, L.; Segala, D.; Leoncini, F.; Mazzotta, F.; Pozzi, M.; Cassola, G.; Viscoli, G.; Viscoli, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Chiodera, A.; Castelli, P.; Rizzardini, G.; Ridolfo, A. L.; Foschi, A.; Salpietro, S.; Galli, A.; Bigoloni, A.; Spagnuolo, V.; Merli, S.; Carenzi, L.; Moioli, M. C.; Cicconi, P.; Bisio, L.; Gori, A.; Lapadula, G.; Abrescia, N.; Chirianni, A.; de Marco, M.; Ferrari, C.; Borghi, R.; Baldelli, F.; Belfiori, B.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; Narciso, P.; Tozzi, V.; Vullo, V.; d'Avino, A.; Zaccarelli, M.; Gallo, L.; Acinapura, R.; Capozzi, M.; Libertone, R.; Trotta, M. P.; Tebano, G.; Cattelan, A. M.; Mura, M. S.; Caramello, P.; Orofino, G. C.; Sciandra, M.; Raise, N. N.; Ebo, F.; Pellizzer, G.; Manfrin, V.; Law, M.; Petoumenos, K.; McManus, H.; Wright, S.; Bendall, C.; Moore, R.; Edwards, S.

    2013-01-01

    Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV

  3. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: Findings from a large multiethnic registry.

    Science.gov (United States)

    Copeland-Halperin, Robert S; Baber, Usman; Aquino, Melissa; Rajamanickam, Anitha; Roy, Swathi; Hasan, Choudhury; Barman, Nitin; Kovacic, Jason C; Moreno, Pedro; Krishnan, Prakash; Sweeny, Joseph M; Mehran, Roxana; Dangas, George; Kini, Annapoorna S; Sharma, Samin K

    2018-04-01

    We sought to determine the prevalence, predictors, and clinical impact of target lesion calcification in patients undergoing percutaneous coronary intervention (PCI) with newer generation drug-eluting stents (DES) and devices. Coronary calcification is independently associated with adverse outcomes following PCI. While newer DES and contemporary devices are considered safer and more efficacious, their influence on outcomes following PCI of heavily calcified lesions is unknown. We performed a retrospective analysis of a large, multiethnic cohort of patients undergoing PCI with new generation DES at an academic center between 2009 and 2013. Coronary calcification was qualitatively assessed as none/mild, moderate, or severe. Independent demographic, clinical, and anatomic predictors of moderate/severe calcification were identified using logistic regression. Associations between coronary calcification and 1-year MACE (death, myocardial infarction, or target vessel revascularization) were examined using Cox modeling. Compared to patients with none/mild (n = 10,180; 82.0%), those with moderate (n = 1,271; 10.0%) or severe (n = 994; 8.0%) calcification were older, more often Caucasian, had more complex target lesions, and worse renal function. The strongest demographic, clinical, and anatomic correlates of moderate/severe calcification were age, Caucasian race, renal dysfunction, lesion length, and left main location. Unadjusted MACE rates among those with none/mild, moderate, and severe calcification were 8.3, 14.6, and 17.8%, respectively (P < 0.001). After multivariable adjustment, the hazard ratio (95% CI) for MACE associated with moderate or severe coronary calcification was 1.63. Target lesion calcification remains independently associated with adverse outcomes in patients treated with newer generation DES and modern devices. © 2017 Wiley Periodicals, Inc.

  4. No Fault Found events in maintenance engineering Part 2: Root causes, technical developments and future research

    International Nuclear Information System (INIS)

    Khan, Samir; Phillips, Paul; Hockley, Chris; Jennions, Ian

    2014-01-01

    This is the second half of a two paper series covering aspects of the no fault found (NFF) phenomenon, which is highly challenging and is becoming even more important due to increasing complexity and criticality of technical systems. Part 1 introduced the fundamental concept of unknown failures from an organizational, behavioral and cultural stand point. It also reported an industrial outlook to the problem, recent procedural standards, whilst discussing the financial implications and safety concerns. In this issue, the authors examine the technical aspects, reviewing the common causes of NFF failures in electronic, software and mechanical systems. This is followed by a survey on technological techniques actively being used to reduce the consequence of such instances. After discussing improvements in testability, the article identifies gaps in literature and points out the core areas that should be focused in the future. Special attention is paid to the recent trends on knowledge sharing and troubleshooting tools; with potential research on technical diagnosis being enumerated

  5. Positive future orientation as a mediator between traumatic events and mental health among children affected by HIV/AIDS in rural China.

    Science.gov (United States)

    Zhang, Jintao; Zhao, Guoxiang; Li, Xiaoming; Hong, Yan; Fang, Xiaoyi; Barnett, Douglas; Lin, Xiuyun; Zhao, Junfeng; Zhang, Liying

    2009-12-01

    The current study was designed to explore the effect of future orientation in mediating the relationship between traumatic events and mental health in children affected by HIV/AIDS in rural China. Cross-sectional data were collected from 1221 children affected by HIV/AIDS (755 AIDS orphans and 466 vulnerable children). Future orientation among children was measured using three indicators (future expectation, hopefulness toward the future, and perceived control over the future). Measures of mental health consisted of depression, loneliness, and self-esteem. Children's experience of any traumatic events was measured using a modified version of the Life Incidence of Traumatic Events-Student Form. Mediation analysis was conducted using structural equation modeling (SEM) methods. Among the children surveyed, most of the traumatic indicators were negatively associated with future expectation, hopefulness, perceived control, and self-esteem, and positively associated with depression and loneliness. The SEM of mediation analysis demonstrated an adequate fit. Future orientation fully mediated the relationship between traumatic events and mental health and accounted for 67.9% of the total effect of traumatic events on mental health. Results of this study support the positive effect of future expectation in mediating the relationship between traumatic events and mental health among children affected by HIV/AIDS in China. Future mental health promotion and intervention efforts targeting children affected by HIV/AIDS should include components that can mitigate the negative impact of traumatic events on their lives. These components may aim to develop children's positive future expectations, increase their hopefulness toward the future, and improve their perceived control over the future.

  6. Impacts of The Future Changes in Extreme Events on Migration in The Middle East

    Science.gov (United States)

    An, Nazan; Turp, M. Tufan; Ozturk, Tugba; Kurnaz, M. Levent

    2016-04-01

    Natural hazards are defined as extreme events that threat people, their homes and their neighborhoods. They damage housing, food production system and other infrastructures. The frequency of natural hazards namely drought, floods can influence the residential decision-making and can cause substantial residential mobility by affecting relatively greater numbers of people in the region. Developing countries are more vulnerable to the impacts of natural hazards. Therefore, environmental migration can be associated with natural hazards especially in the developing countries. Limited water resources and demographic dynamics of the Middle East make the region one of the most affected domains from the impacts of natural hazards. In this study, we consider the relationship between migration as a demographic process and the frequency of natural hazards in the Middle East for the period of 2020 - 2045 with respect to 1980 - 2005 by performing the projection according to the scenario of IPCC, namely RCP8.5 through the RegCM4.4 and combining them with an econometric analysis. This research has been supported by Boǧaziçi University Research Fund Grant Number 10421.

  7. Lessons learnt from past Flash Floods and Debris Flow events to propose future strategies on risk management

    Science.gov (United States)

    Cabello, Angels; Velasco, Marc; Escaler, Isabel

    2010-05-01

    Floods, including flash floods and debris flow events, are one of the most important hazards in Europe regarding both economic and life loss. Moreover, changes in precipitation patterns and intensity are very likely to increase due to the observed and predicted global warming, rising the risk in areas that are already vulnerable to floods. Therefore, it is very important to carry out new strategies to improve flood protection, but it is also crucial to take into account historical data to identify high risk areas. The main objective of this paper is to show a comparative analysis of the flood risk management information compiled in four test-bed basins (Llobregat, Guadalhorce, Gardon d'Anduze and Linth basins) from three different European countries (Spain, France and Switzerland) and to identify which are the lessons learnt from their past experiences in order to propose future strategies on risk management. This work is part of the EU 7th FP project IMPRINTS which aims at reducing loss of life and economic damage through the improvement of the preparedness and the operational risk management of flash flood and debris flow (FF & DF) events. The methodology followed includes the following steps: o Specific survey on the effectivity of the implemented emergency plans and risk management procedures sent to the test-bed basin authorities that participate in the project o Analysis of the answers from the questionnaire and further research on their methodologies for risk evaluation o Compilation of available follow-up studies carried out after major flood events in the four test-bed basins analyzed o Collection of the lessons learnt through a comparative analysis of the previous information o Recommendations for future strategies on risk management based on lessons learnt and management gaps detected through the process As the Floods Directive (FD) already states, the flood risks associated to FF & DF events should be assessed through the elaboration of Flood Risk

  8. The association of surgical versus natural menopause with future left ventricular structure and function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

    Science.gov (United States)

    Appiah, Duke; Schreiner, Pamela J; Nwabuo, Chike C; Wellons, Melissa F; Lewis, Cora E; Lima, Joao A

    2017-11-01

    To evaluate the association between surgical menopause (SM) versus natural menopause (NM) in relation to later left ventricular (LV) structure and function, while taking into account the LV parameters and other cardiovascular disease risk factor (CVDRF) levels that predate the menopausal transition. We studied 825 premenopausal women from the Coronary Artery Risk Development in Young Adults study in 1990 to 1991 (baseline, mean age 32 years) who later reached menopause by 2010 to 2011 and had echocardiograms at these two time points. During 20 years of follow-up, 508 women reached NM, whereas 317 underwent SM (34% had bilateral oophorectomy). At baseline, women who later underwent SM were more likely to be black, younger, have greater parity, and higher mean values of systolic blood pressure, body mass index, and also lower mean high-density lipoprotein cholesterol and physical activity than women who reached NM. No significant differences in LV structure/function were found between groups. In 2010 to 2011, SM women had significantly higher LV mass, LV mass/volume ratio, E/e' ratio, and impaired longitudinal and circumferential strain than NM women. SM women with bilateral oophorectomy had adverse LV measures than women with hysterectomy with ovarian conservation. Controlling for baseline echocardiographic parameters and CVDRF in linear regression models eliminated these differences between groups. Further adjustment for age at menopause/surgery and hormone therapy use did not change these results. In this study, the adverse LV structure and function observed among women with SM compared with NM were explained by their unfavorable presurgical CVDRF profiles, suggesting that premenopausal CVDRF rather than gynecologic surgery predispose SM women to elevated future cardiovascular disease risk.

  9. CN earthquake prediction algorithm and the monitoring of the future strong Vrancea events

    International Nuclear Information System (INIS)

    Moldoveanu, C.L.; Radulian, M.; Novikova, O.V.; Panza, G.F.

    2002-01-01

    The strong earthquakes originating at intermediate-depth in the Vrancea region (located in the SE corner of the highly bent Carpathian arc) represent one of the most important natural disasters able to induce heavy effects (high tool of casualties and extensive damage) in the Romanian territory. The occurrence of these earthquakes is irregular, but not infrequent. Their effects are felt over a large territory, from Central Europe to Moscow and from Greece to Scandinavia. The largest cultural and economical center exposed to the seismic risk due to the Vrancea earthquakes is Bucharest. This metropolitan area (230 km 2 wide) is characterized by the presence of 2.5 million inhabitants (10% of the country population) and by a considerable number of high-risk structures and infrastructures. The best way to face strong earthquakes is to mitigate the seismic risk by using the two possible complementary approaches represented by (a) the antiseismic design of structures and infrastructures (able to support strong earthquakes without significant damage), and (b) the strong earthquake prediction (in terms of alarm intervals declared for long, intermediate or short-term space-and time-windows). The intermediate term medium-range earthquake prediction represents the most realistic target to be reached at the present state of knowledge. The alarm declared in this case extends over a time window of about one year or more, and a space window of a few hundreds of kilometers. In the case of Vrancea events the spatial uncertainty is much less, being of about 100 km. The main measures for the mitigation of the seismic risk allowed by the intermediate-term medium-range prediction are: (a) verification of the buildings and infrastructures stability and reinforcement measures when required, (b) elaboration of emergency plans of action, (c) schedule of the main actions required in order to restore the normality of the social and economical life after the earthquake. The paper presents the

  10. Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons

    OpenAIRE

    Rotger, Margalida; Glass, Tracy R; Junier, Thomas; Lundgren, Jens; Neaton, James D; Poloni, Estella S; van 't Wout, Angélique B; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle

    2013-01-01

    BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. METHODS: In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the ...

  11. Duration of dual antiplatelet therapy in acute coronary syndrome.

    Science.gov (United States)

    Wilson, Simon John; Newby, David E; Dawson, Dana; Irving, John; Berry, Colin

    2017-04-01

    Despite a large volume of evidence supporting the use of dual antiplatelet therapy in patients with acute coronary syndrome, there remains major uncertainty regarding the optimal duration of therapy. Clinical trials have varied markedly in the duration of therapy, both across and within trials. Recent systematic reviews and meta-analyses suggest that shorter durations of dual antiplatelet therapy are superior because the avoidance of atherothrombotic events is counterbalanced by the greater risks of excess major bleeding with apparent increases in all-cause mortality with longer durations. These findings did not show significant heterogeneity according to whether patients had stable or unstable coronary heart disease. Moreover, the potential hazards and benefits may differ when applied to the general broad population of patients encountered in everyday clinical practice who have markedly higher bleeding and atherothrombotic event rates. Clinicians lack definitive information regarding the duration of therapy in patients with acute coronary syndrome and risk scores do not appear to be sufficiently robust to address these concerns. We believe that there is a pressing need to undertake a broad inclusive safety trial of shorter durations of therapy in real world populations of patients with acute coronary syndrome. The clinical evidence would further inform future research into strategies for personalised medicine. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

    Directory of Open Access Journals (Sweden)

    Ron Blankstein

    2017-03-01

    Full Text Available Over the last two decades coronary artery calcium (CAC scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300 have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year, with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

  13. Role of B-Type Natriuretic Peptide and N-Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Wolsk, Emil; Claggett, Brian; Pfeffer, Marc A; Diaz, Rafael; Dickstein, Kenneth; Gerstein, Hertzel C; Lawson, Francesca C; Lewis, Eldrin F; Maggioni, Aldo P; McMurray, John J V; Probstfield, Jeffrey L; Riddle, Matthew C; Solomon, Scott D; Tardif, Jean-Claude; Køber, Lars

    2017-05-29

    Natriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B-type natriuretic peptide (BNP) and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus. Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow-up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/NT-proBNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT-proBNP to best risk models. Overall, BNP and NT-proBNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77-0.82, P type 2 diabetes mellitus, BNP and NT-proBNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  14. The behavior of crude oil spot and futures prices around OPEC and SPR announcements: An event study perspective

    International Nuclear Information System (INIS)

    Demirer, Riza; Kutan, Ali M.

    2010-01-01

    This paper examines the informational efficiency of crude oil spot and futures markets with respect to OPEC conference and U.S. Strategic Petroleum Reserve (SPR) announcements. We employ the event study methodology to examine the abnormal returns in crude oil spot and futures markets around OPEC conference and SPR announcement dates between 1983 and 2008. Our findings regarding OPEC announcements indicate an asymmetry in that only OPEC production cut announcements yield a statistically significant impact with the impact diminishing for longer maturities. We also find that the persistence of returns following OPEC production cut announcements creates substantial excess returns to investors who take long positions on the day following the end of OPEC conferences. In the case of SPR announcements, we find that the government's use of this program initiates a short-run market reaction following the announcement date. Furthermore, our tests of cumulative abnormal returns suggest that the market reacts efficiently to SPR announcements providing support for the use of the strategic reserves as a tool to stabilize the oil market. Our findings have significant policy implications for investors and are useful in designing effective energy policy strategies.

  15. Plasma concentrations of ascorbic acid and C-reactive protein, and risk of future coronary artery disease, in apparently healthy men and women: the EPIC-Norfolk prospective population study.

    Science.gov (United States)

    Boekholdt, S Matthijs; Meuwese, Marijn C; Day, Nicholas E; Luben, Robert; Welch, Ailsa; Wareham, Nicholas J; Khaw, Kay-Tee

    2006-09-01

    High plasma concentrations of ascorbic acid, a marker of fruit and vegetable intake, are associated with low risk of coronary artery disease. Whether this relationship is explained by a reduction in systemic inflammation is unclear. We investigated the relationship between ascorbic acid plasma concentration and coronary artery disease risk, and in addition whether this relationship depended on classical risk factors and C-reactive protein (CRP) concentration. We used a prospective nested case-control design. The study consisted of 979 cases and 1794 controls (1767 men and 1006 women). Increasing ascorbic acid quartiles were associated with lower age, BMI, systolic and diastolic blood pressure, and CRP concentration, but with higher HDL-cholesterol concentration. No associations existed between ascorbic acid concentration and total cholesterol concentration or LDL-cholesterol concentration. When data from men and women were pooled, the risk estimates decreased with increasing ascorbic acid quartiles such that people in the highest ascorbic acid quartile had an odds ratio for future coronary artery disease of 0.67 (95 % CI 0.52, 0.87) compared with those in the lowest quartile (P for linearity=0.001). This relationship was independent of sex, age, diabetes, smoking, BMI, LDL-cholesterol, HDL-cholesterol, systolic blood pressure and CRP level. These data suggest that the risk reduction associated with higher ascorbic acid plasma concentrations, a marker of fruit and vegetable intake, is independent of classical risk factors and also independent of CRP concentration.

  16. Assessment of myocardial blood flow and coronary flow reserve with positron emission tomography in ischemic heart disease: current state and future directions.

    Science.gov (United States)

    Al Badarin, Firas; Aljizeeri, Ahmed; Almasoudi, Fatimah; Al-Mallah, Mouaz H

    2017-07-01

    Positron emission tomography (PET) is a versatile imaging technology that allows assessment of myocardial perfusion, both at a spatially relative scale and also in absolute terms, thereby enabling noninvasive evaluation of myocardial blood flow (MBF) and coronary flow reserve (CFR). Assessment of MBF using FDA-approved PET isotopes, such as 82 Rb and 13 N-ammonia, has been well validated, and several software packages are currently available, thereby allowing for MBF evaluation to be incorporated into routine workflow in contemporary nuclear laboratories. Incremental diagnostic and prognostic information provided with the knowledge of MBF has the potential for widespread applications. Improving the ability to identify the true burden of obstructive epicardial coronary stenoses and allowing for noninvasive assessment of coronary micro circulatory function can be achieved with MBF assessment. On the other hand, attenuated CFR has been shown to predict adverse cardiovascular prognosis in a variety of clinical settings and patient subgroups. With expanding applications of MBF, this tool promises to provide unique insight into the integrity of the entire coronary vascular bed beyond what is currently available with relative perfusion assessment. This review intends to provide an in-depth discussion of technical and clinical aspects of MBF assessment with PET as it relates to patients with ischemic heart disease.

  17. [Inflammatory biomarkers in ischemic acute coronary syndrome].

    Science.gov (United States)

    Domínguez-Rodríguez, Alberto; Abreu-González, Pedro

    2015-10-01

    Diagnosing acute coronary syndrome (ACS) in the emergency department is often a complex process. Inflammatory markers might be useful for the rapid assessment of a patient's overall risk and might also help predict future episodes. The clinical use of these biomarkers could potentially lower the number of emergency visits and help in the prevention of future adverse events. The aim of this review was to evaluate the clinical utility of markers of cardiovascular inflammation in emergency patients with ACS. Based on a critical analysis of a selection of the literature, we concluded that none of the biomarkers of cardiovascular inflammation would at present be useful for stratifying risk in emergency situations, aiding prognosis, or guiding therapy for patients with ACS.

  18. Prognostic value of intravenous dipyridamole thallium scintigraphy after an acute myocardial ischemic event

    International Nuclear Information System (INIS)

    Younis, L.T.; Byers, S.; Shaw, L.; Barth, G.; Goodgold, H.; Chaitman, B.R.

    1989-01-01

    Seventy-seven patients recovering from an acute coronary event were studied by intravenous dipyridamole thallium scintigraphy to evaluate the prognostic value and safety of the test in this patient subset. Forty-four patients (58%) had unstable angina and 33 (42%) had an acute myocardial infarction. One death occurred within 24 hours of testing. Sixty-eight patients were followed for an average of 12 months; 25, 31 and 23% had a fixed, reversible or combined thallium defect on their predischarge thallium scan. During follow-up, 10 patients died or had a nonfatal myocardial infarction; in each case, a reversible or combined myocardial thallium defect was present. Univariate analysis of 17 clinical, scintigraphic and angiographic variables showed that a reversible thallium defect and the angiographically determined extent of coronary artery disease were predictors of future cardiac events. The extent of coronary disease and global left ventricular ejection fraction were predictors of subsequent reinfarction or death. Logistic regression analyses revealed that a reversible thallium defect (p less than 0.001) and the extent of coronary disease (p less than 0.009) were the only significant predictors of a cardiac event. When death or reinfarction were the outcome variables, the extent of coronary disease (p less than 0.02) and left ventricular ejection fraction (p less than 0.06) were the only variables selected. Thus, intravenous dipyridamole thallium scintigraphy after an acute coronary ischemic syndrome is a useful and relatively safe noninvasive test to predict subsequent cardiac events

  19. β-Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In-Hospital and 12-Month Outcome: Results From the GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2).

    Science.gov (United States)

    Abi Khalil, Charbel; AlHabib, Khalid F; Singh, Rajvir; Asaad, Nidal; Alfaleh, Hussam; Alsheikh-Ali, Alawi A; Sulaiman, Kadhim; Alshamiri, Mostafa; Alshaer, Fayez; AlMahmeed, Wael; Al Suwaidi, Jassim

    2017-12-20

    The prognostic impact of β-blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in-hospital outcome in patients without HF, and whether they also reduce 12-month mortality if still prescribed on discharge. The GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in-hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1-year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in-hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non-BB group. Even after correcting for confounding factors in 2 different models, in-hospital and 12-month mortality risk was still lower in the BB group. In this cohort of ACS, BB therapy before admission for ACS is associated with decreased in-hospital mortality and major cardiovascular events, and 1-year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  1. Effect of cytochrome P450 2C19 polymorphism on adverse cardiovascular events after drug-eluting stent implantation in a large Hakka population with acute coronary syndrome receiving clopidogrel in southern China.

    Science.gov (United States)

    Zhong, Zhixiong; Hou, Jingyuan; Zhang, Qifeng; Li, Bin; Li, Cunren; Liu, Zhidong; Yang, Min; Zhong, Wei; He, Xuebo; Wu, Hesen; Zhong, Miaocai; Zhao, Pingsen

    2018-04-01

    The objective of this study is to evaluate the effects of cytochrome P450 2C19 (CYP2C19) polymorphism on adverse cardiovascular events (MACE) in Hakka patients with acute coronary syndrome (ACS) receiving clopidogrel who had undergone coronary drug-eluting stent placement after percutaneous coronary intervention (PCI) in southern China. Genotyping of CYP2C19 and MACE of 934 ACS patients with PCI on clopidogrel maintenance therapy were analyzed. Patients who carried loss-of-function CYP2C19 were treated with a 150-mg maintenance dose of clopidogrel or 90 mg of ticagrelor antiplatelet therapy, and patients who were non-carriers received clopidogrel therapy daily at a maintenance dose of 75 mg and the patients were followed-up for at least 12 months. The primary efficacy endpoint was a composite of cardiovascular death, myocardial infarction, and target vessel revascularization and stroke. The allelic frequency of CYP2C19*2 and CYP2C19*3 of Hakka patients in the current study was 31.64 and 5.19%, respectively. The CYP2C19 wild-type homozygotes (*1/*1) were the most predominant among the patients (40.36%), followed by the CYP2C19*2 heterozygotes (*1/*2) (40.26%). The distribution of CYP2C19 phenotypes was divided into extensive metabolizers (EM; 40.36%), intermediate metabolizers (IM; 45.61%), and poor metabolizers (PM; 14.03%). Based on the genotype-guided antiplatelet therapy, there was no significant association between the carrier status and the clinical outcome at 1, 6, and 12 months. In addition, no significant difference in the rates of bleeding was found among the three groups. After logistic regression analysis, hypertension was the only independent predictor of cardiovascular events (relative risk, 1.501; 95% CI, 1.011 to 2.229; P = 0.044). Our results shed new light on the important benefit of testing CYP2C19 polymorphisms before prescribing clopidogrel in patients treated with drug-eluting stent implantation after PCI. The testing may help to

  2. Compliance with and short-term adverse events from clarithromycin versus placebo in patients with stable coronary heart disease: the CLARICOR trial

    DEFF Research Database (Denmark)

    Jespersen, C M; Kolmos, H J; Frydendall, N

    2009-01-01

    mg of clarithromycin daily versus 2200 patients to matching placebo for 14 days. This paper presents protocol-specified analysis of the patient-reported information regarding their compliance and non-serious adverse events during the 14 days of treatment as well as serious adverse events (mortality...

  3. Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: results from the PROSPECT study.

    Science.gov (United States)

    Shimizu, Takehisa; Mintz, Gary S; De Bruyne, Bernard; Farhat, Naim Z; Inaba, Shinji; Cao, Yang; Marso, Steven P; Weisz, Giora; Serruys, Patrick W; Stone, Gregg W; Maehara, Akiko

    2018-05-17

    Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention. Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, PPROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85). The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.

  4. Derivation of working levels for animal feedstuffs for use in the event of a future nuclear accident

    International Nuclear Information System (INIS)

    Nisbet, A.; Woodman, R.; Brown, J.

    1998-04-01

    In the event of a future nuclear accident, European Council Food Intervention Levels (CFILs) would be legally binding for foodstuffs marketed in the UK. Practical guidance has been developed on the activity concentrations of radiocaesium and radiostrontium in animal feedstuffs that would give rise to concentrations equivalent to the relevant CFIL in the final animal product. The animals considered were dairy and beef cattle, lambs, pigs, broiler chickens and laying hens. Typical diets have been derived for each animal. The NRPB foodchain model FARMLAND has been used to predict activity concentrations in different feedstuffs for accidents occurring at different times of the year. The predicted concentrations were combined with the data on dietary composition, information on feed-to-product transfer and the relevant CFIL to estimate the corresponding Working levels in Animal Feedstuffs (WAFs). The calculations were carried out using a dedicated software system called SILAFOD. This flexible system can be used to carry out more specific assessments. A handbook that accompanies this report contains detailed information on animal diets, contributions from various feedstuffs to intakes of activity and the corresponding WAFs. The early phase after an accident and the longer-term phase are both considered. The work received partial financial support from the Ministry of Agriculture, Fisheries and Food, Radiological Safety and Nutrition Division. (author)

  5. Futures

    DEFF Research Database (Denmark)

    Pedersen, Michael Haldrup

    2017-01-01

    Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores the potenti......Currently both design thinking and critical social science experience an increased interest in speculating in alternative future scenarios. This interest is not least related to the challenges issues of global sustainability present for politics, ethics and design. This paper explores...... the potentials of speculative thinking in relation to design and social and cultural studies, arguing that both offer valuable insights for creating a speculative space for new emergent criticalities challenging current assumptions of the relations between power and design. It does so by tracing out discussions...... of ‘futurity’ and ‘futuring’ in design as well as social and cultural studies. Firstly, by discussing futurist and speculative approaches in design thinking; secondly by engaging with ideas of scenario thinking and utopianism in current social and cultural studies; and thirdly by showing how the articulation...

  6. Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Valenta, Ines; Schepis, Tiziano [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); Husmann, Lars; Scheffel, Hans; Desbiolles, Lotus; Leschka, Sebastian; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 32, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2008-06-15

    The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 {+-} 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 {+-} 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001). Similarly, obstructive lesions ({>=}50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis. (orig.)

  7. Effect of Prior Aspirin Treatment on Patients With Acute Coronary Syndromes: Insights From the PROSPECT Study.

    Science.gov (United States)

    Brener, Sorin J; Maehara, Akiko; Mintz, Gary S; Weisz, Giora; de Bruyne, Bernard; Serruys, Patrick W; Stone, Gregg W

    2015-12-01

    Prior aspirin treatment is considered a risk factor for adverse outcomes in acute coronary syndrome (ACS) patients. The relationships between aspirin pretreatment and findings on quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS), as well as clinical outcomes, are not well understood. In the PROSPECT trial, QCA and triple-vessel IVUS imaging were performed after successful percutaneous coronary intervention (PCI) of the culprit lesion(s) in ACS patients. We compared patients receiving aspirin within 7 days of enrollment to those naive to aspirin. Propensity score matching was performed to adjust for differences in baseline characteristics. Aspirin-pretreated patients (n = 236; 35%) were older and more likely to have known coronary disease than those without pretreatment (P≤.01 for all). Pretreated patients had more untreated non-culprit lesions with angiographic and IVUS characteristics predictive of future events (53.1% vs 38.6%; PPROSPECT trial, aspirin pretreatment identifies an older population with more advanced coronary disease. Aspirin pretreatment was not an independent predictor of MACE in ACS patients treated with an early invasive strategy. The extent to which aspirin pretreatment is a risk factor for adverse events after PCI in ACS should be revisited.

  8. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery : A five year longitudinal cohort study

    NARCIS (Netherlands)

    Tully, P.J.; Winefield, H.R.; Baker, R.A.; Denollet, Johan; Pedersen, S.S.; Wittert, G.A.; Turnbull, D.

    2015-01-01

    Background Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical

  9. Effect of vorapaxar on myocardial infarction in the thrombin receptor antagonist for clinical event reduction in acute coronary syndrome (TRA·CER) trial.

    Science.gov (United States)

    Leonardi, Sergio; Tricoci, Pierluigi; White, Harvey D; Armstrong, Paul W; Huang, Zhen; Wallentin, Lars; Aylward, Philip E; Moliterno, David J; Van de Werf, Frans; Chen, Edmond; Providencia, Luis; Nordrehaug, Jan E; Held, Claes; Strony, John; Rorick, Tyrus L; Harrington, Robert A; Mahaffey, Kenneth W

    2013-06-01

    The TRA·CER trial compared vorapaxar, a novel platelet protease-activated receptor (PAR)-1 antagonist, with placebo in 12 944 patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACS). In this analysis, we explored the effect of vorapaxar on myocardial infarction (MI). A blinded, independent central endpoint adjudication committee prospectively defined and classified MI according to the universal MI definition, including peak cardiac marker value (creatine kinase-MB [CK-MB] and/or troponin). Because the trial failed to meet its primary endpoint, these analyses are considered exploratory. During a median follow-up of 502 days, 1580 MIs occurred in 1319 patients. The majority (n = 1025, 64.9%) were type 1 (spontaneous) MI, followed by type 4a [percutaneous coronary intervention (PCI)-related] MI (n = 352; 22.3%). Compared with placebo, vorapaxar reduced the hazard of a first MI of any type by 12% [hazard ratio (HR), 0.88; 95% confidence interval (CI), 0.79-0.98; P = 0.021] and the hazard of total number of MIs (first and subsequent) by 14% (HR, 0.86; 95% CI, 0.77-0.97; P = 0.014), an effect that was sustained over time. Vorapaxar reduced type 1 MI by 17% (HR, 0.83; 95% CI, 0.73-0.95; P = 0.007). Type 4a MIs were not significantly reduced by vorapaxar (HR, 0.90; 95% CI, 0.73-1.12; P = 0.35). Vorapaxar effect was consistent across MI sizes defined by peak cardiac marker elevations and across key clinical subgroups; however, in patients not treated with thienopyridine at baseline (HR, 0.65; 95% CI, 0.46-0.92) compared with patients who received thienopyridine (HR, 0.91; 95% CI, 0.81-1.02), there was a trend towards a higher effect (Pint = 0.077). The PAR-1 antagonist vorapaxar was associated with a reduction of MI, including total number of infarctions. This reduction was sustained over time and was mostly evident in type 1 MI, the most common type of MI observed.

  10. Revisiting the past and back to the future: memory systems and the linguistic representation of social events.

    NARCIS (Netherlands)

    Semin, G.R.; Smith, E.R.

    1999-01-01

    Five studies were conducted to investigate the relationship between how people communicate about social events and how representations of these events are stored in memory. It was hypothesized that more distant events in memory would be described with more abstract linguistic predicates, and recent

  11. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    -blind placebo-controlled trials could not confirm the initial high efficacy of either the growth factor protein or the gene therapy approaches observed in earlier small trials. The clinical studies so far have all been without any gene-related serious adverse events. Future trials will focus on whether...... an improvement in clinical results can be obtained with a cocktail of growth factors or by a combination of gene and stem cell therapy in patients with severe coronary artery disease, which cannot be treated effectively with current treatment strategies....... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...

  12. The co-existence of the IL-18+183 A/G and MMP-9 -1562 C/T polymorphisms is associated with clinical events in coronary artery disease patients.

    Directory of Open Access Journals (Sweden)

    Trine B Opstad

    Full Text Available Interleukin (IL-18 has been associated with severity of atherosclerosis and discussed to predict cardiovascular (CV events. We have previously shown that the IL-18+183 G-allele significantly reduces IL-18 levels. This study was aimed to investigate the prognostic significance of the IL-18+183 A/G polymorphism (rs5744292, single and in coexistence with the matrix metalloproteinase (MMP-9 -1562 C/T (rs3918242 polymorphism, in patients with stable coronary artery disease (CAD. Serum levels of IL-18, MMP-9 and tissue inhibitor of matrix metalloproteinase (TIMP-1 were additionally assessed.1001 patients with angiographically verified CAD were genotyped and the biomarkers were measured accordingly. After two years follow-up, 10.6% experienced new clinical events; acute myocardial infarction (AMI, stroke, unstable angina pectoris and death.The IL-18+183 G-allele associated with 35% risk reduction in composite endpoints after adjusting for potential covariates (p = 0.044. The IL-18+183 AA/MMP-9 -1562 CT/TT combined genotypes associated with a significant increase in risk of composite endpoints (OR = 1.87; 95% CI = 1.13-3.11, p = 0.015, adjusted. Patients with clinical events presented with significantly higher IL-18 levels as compared to patients without (p = 0.011, adjusted. The upper tertile of IL-18 levels associated with an increase in risk of AMI as compared to lower tertiles (OR = 2.36; 95% CI = 1.20-4.64, p = 0.013, adjusted.The IL-18+183 A/G polymorphism, single and in combination with MMP-9 genotypes, may influence the risk of clinical events in stable CAD patients.

  13. High-Dose Statin Pretreatment Decreases Periprocedural Myocardial Infarction and Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of Twenty-Four Randomized Controlled Trials

    Science.gov (United States)

    Wang, Le; Peng, Pingan; Zhang, Ou; Xu, Xiaohan; Yang, Shiwei; Zhao, Yingxin; Zhou, Yujie

    2014-01-01

    Background Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. Methods We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. Results Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; Pstatin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P = 0.12). Long-term effects on survival were less obvious. Conclusions High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for

  14. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  15. Hour Glass Half-Full or Half-Empty? Future Time Perspective and Preoccupation with Negative Events Across the Life Span

    Science.gov (United States)

    Strough, JoNell; de Bruin, Wändi Bruine; Parker, Andrew M.; Lemaster, Philip; Pichayayothin, Nipat; Delaney, Rebecca

    2016-01-01

    According to socioemotional selectivity theory, older adults' emotional well-being stems from having limited future time perspective that motivates them to maximize well-being in the “here and now.” Presumably, then, older adults' time horizons are associated with emotional competencies that boost positive affect and dampen negative affect, but little research has addressed this. Using a US national adult life-span sample (N= 3,933, 18-93 yrs), we found that a two-factor model of future time perspective (focus on future opportunities; focus on limited time) fit the data better than a one-factor model. Through middle age, people perceived the life-span hourglass as half full—they focused more on future opportunities than limited time. Around age 60, the balance changed to increasingly perceiving the life-span hourglass as half empty—they focused less on future opportunities and more on limited time. This pattern held even after accounting for perceived health, self-reported decision-making ability, and retirement status. At all ages, women's time horizons focused more on future opportunities compared to men's, and men's focused more on limited time. Focusing on future opportunities was associated with reporting less preoccupation with negative events, whereas focusing on limited time was associated with reporting more preoccupation. Older adults reported less preoccupation with negative events and this association was stronger after controlling for their perceptions of limited time and fewer future opportunities, suggesting that other pathways may explain older adults' reports of their ability to disengage from negative events. Insights gained and questions raised by measuring future time perspective as two dimensions are discussed. PMID:27267222

  16. Novel aspects of acute coronary syndromes, reperfusion injury and post-infarction myocardial fibrosis

    OpenAIRE

    Chan, William

    2017-01-01

    This thesis comprises 4 clinical studies aiming to explore the mechanisms related to coronary plaque destabilization, clinical outcomes of the no-reflow phenomenon, a novel treatment of ischaemia-reperfusion injury, and the pattern and temporal evolution of left ventricular myocardial fibrosis following myocardial infarction. Current risk prediction models for future cardiovascular events are derived from large scale population-based studies (such as that from the Framingham Heart Study),...

  17. Influence of psychological and coronary parameters on coronary patient rehospitalization

    Directory of Open Access Journals (Sweden)

    Nikolić Gordana

    2010-01-01

    Full Text Available Introduction. Psychological reactions are often comorbid with coronary risk factors and could be important for a six-month outcome. Objective. Determination of anxiety level, depression and aggression, persistence of risk health behaviour, stress life events, and coronary risk factors after coronary event and a predictive value of those parameters for six-month rehospitalization. Methods. In the group with Angina Pectoris (E1=30 and the group with Acute Myocardial Infarction (E2=33, there were applied, at baseline and after 6 months, the following: Semistructured Clinical Interview based on ICD-10, for depressive episode and anxiety disorder, Hamilton Anxiety Scale (HAMA, Hamilton Depression Scale (HAMD, KON-6 sigma Scale for aggression, Holms-Rahe Scale (H-R for stress events and Questionnaire for risk behaviour: alcohol consumption, smoking, lack of physical activity. Group differences were assessed by t-test and chi-square test, p<0.05, regression analysis for assessing initial variables, a predictive value for six month rehospitalization. Results. After acute coronary event, the anxiety and depression levels were mild and aggression was low in E1 and mild in E2. Stress event score was significantly higher in E2 (H-R=115.18 than in E1 (H-R=72.20, p<0.05. After 6 months, the results were the same except for a significantly lower stress event score in E1 (H-R=49.48, and in E2 (H-R=91.65, but still significantly higher than in E1. Coronary parameters were reduced, smokers' rate was increased in E1. Alcohol consumption, hypercholesterolaemia and hereditary tendency were predictive for six- month rehospitalization. Conclusion. After acute cardiac event, hospitalized coronary patients had a mild anxiety, depression and aggression level as well as after six months. The infarct patients had experienced more stress life events in the previous year than the angina patients. Risk health behaviour did not change in the following six months, with the

  18. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: A five year longitudinal cohort study

    NARCIS (Netherlands)

    P.J. Tully (Phillip); H.R. Winefield (Helen); R.A. Baker (Robert); J. Denollet (Johan); S.S. Pedersen (Susanne); G.A. Wittert (Gary); D.A. Turnbull (Deborah)

    2015-01-01

    textabstractBackground: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between

  19. Coronary ostium occlusion by coronary cusp displacement in Williams syndrome.

    Science.gov (United States)

    Shiohama, Tadashi; Fujii, Katsunori; Ebata, Ryota; Funabashi, Nobusada; Matsumiya, Goro; Saito, Yuko Kazato; Takechi, Fumie; Yonemori, Yoko; Nakatani, Yukio; Shimojo, Naoki

    2016-06-01

    Williams syndrome is a contiguous gene deletion syndrome resulting from a heterozygous deletion on chromosome 7q11.23, and is characterized by distinctive facial features and supravalvular aortic stenosis (SVAS). This syndrome rarely presents unpredictable cardiac death, and yet, as illustrated in the present case, it is still not possible to predict it, even on close monitoring. We herein describe the case of a 6-year-old Japanese girl with Williams syndrome, who had sudden cardiac collapse due to cardiac infarction after pharyngitis. Cardiac failure followed a critical course that did not respond to catecholamine support or heart rest with extracardiac mechanical support. Although marked coronary stenosis was not present, the left coronary cusp abnormally adhered to the aortic wall, which may synergistically cause coronary ostium occlusion with SVAS. Altered hemodynamic state, even that caused by the common cold, may lead to critical myocardial events in Williams syndrome with SVAS. © 2015 Japan Pediatric Society.

  20. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik

    Introduction: A family history of premature coronary artery disease (CAD) is a well-known risk factor for adverse coronary events with age of onset being inversely related to the degree of heritability. Hypothesis: We hypothesized that asymptomatic first degree relatives, of patients with premature...... CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic...

  1. Behavioral control blunts reactions to contemporaneous and future adverse events: Medial prefrontal cortex plasticity and a corticostriatal network

    Directory of Open Access Journals (Sweden)

    Steven F. Maier

    2015-01-01

    Full Text Available It has been known for many years that the ability to exert behavioral control over an adverse event blunts the behavioral and neurochemical impact of the event. More recently, it has become clear that the experience of behavioral control over adverse events also produces enduring changes that reduce the effects of subsequent negative events, even if they are uncontrollable and quite different from the original event controlled. This review focuses on the mechanism by which control both limits the impact of the stressor being experienced and produces enduring, trans-situational “immunization”. The evidence will suggest that control is detected by a corticostriatal circuit involving the ventral medial prefrontal cortex (mPFC and the posterior dorsomedial striatum (DMS. Once control is detected, other mPFC neurons that project to stress-responsive brainstem (dorsal raphe nucleus, DRN and limbic (amygdala structures exert top–down inhibitory control over the activation of these structures that is produced by the adverse event. These structures, such as the DRN and amygdala, in turn regulate the proximate mediators of the behavioral and physiological responses produced by adverse events, and so control blunts these responses. Importantly, the joint occurrence of control and adverse events seems to produce enduring plastic changes in the top–down inhibitory mPFC system such that this system is now activated by later adverse events even if they are uncontrollable, thereby reducing the impact of these events. Other issues are discussed that include a whether other processes such as safety signals and exercise, that lead to resistance/resilience, also use the mPFC circuitry or do so in other ways; b whether control has similar effects and neural mediation in humans, and c the relationship of this work to clinical phenomena.

  2. Management of suspected acute coronary syndrome patients admitted to cardiology or non-cardiology services at Auckland City Hospital: implications for future national data collection.

    Science.gov (United States)

    Wang, Tom Kai Ming; Chow, Kok-Lam; Lin, Aaron; Chataline, Alexei; White, Harvey; Dawes, Matthew; Gamble, Greg; Ellis, Chris

    2018-03-09

    To review the number, characteristics and clinical management of suspected ACS patients admitted to cardiology and non-cardiology services at Auckland City Hospital, to assess differences between these services and to assess the number who would potentially be enrolled in the All New Zealand Acute Coronary Syndrome (ACS) Quality Improvement Programme (ANZACS-QI) database. Auckland City Hospital patient data was extracted from the Australia and New Zealand ACS 'SNAPSHOT' audit, performed over 14 days in May 2012. There were 121 suspected ACS admissions to Auckland City hospital during the audit period, with 45 (37%) patients directly managed by the cardiology service, and 76 (63%) patients cared for by non-cardiology services. Based on the subsequent discharge diagnosis, the cardiology service had more patients with definite ACS than the non-cardiology services; 27/45 (60%) compared to 16/76 (21%), difference (95%CI) 39% (22-56), P<0.0001). Cardiology ACS patients were more likely to undergo echocardiography; 15/27 (56%) compared to 2/16 (13%), difference 42% (18-68), P=0.0089), coronary angiography; 21/27 (78%) compared to 3/16 (19%), difference (95%CI) 59% (34-84), P=0.0003), coronary revascularisation; 18/27 (67%) compared to 3/16 (19%), difference (95%CI) 48% (22-74), P=0.004, and be discharged on two antiplatelet agents; 18/26 (69%) compared to 3/15 (20%), difference (95%CI) 49% (22-76), P=0.0036, or an ACEI/ARB; 20/26 (77%) compared to 5/15 (33%), difference (95%CI) 44% (15-72), P=0.0088. In patients with a discharge diagnosis of definite ACS, those managed by non-cardiology services were less likely to receive guideline-recommended investigations, and management, in this relatively small cohort study. About one-third of all ACS patients are managed by non-cardiology services and would not be recorded by the ANZACS-QI database.

  3. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

  4. Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons

    DEFF Research Database (Denmark)

    Rotger, Margalida; Glass, Tracy R; Junier, Thomas

    2013-01-01

    in the setting of HIV infection. METHODS: In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies......, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. RESULTS: A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9 × 10(-4)). In the final multivariable model, participants...

  5. Soluble Urokinase Plasminogen Activator Receptor Level Is an Independent Predictor of the Presence and Severity of Coronary Artery Disease and of Future Adverse Events

    DEFF Research Database (Denmark)

    Eapen, Danny J; Manocha, Pankaj; Ghasemzedah, Nima

    2014-01-01

    (PPPPP...-statistic for a model based on traditional risk factors was improved from 0.72 to 0.74 (P=0.008) with the addition of suPAR. CONCLUSION: Elevated levels of plasma suPAR are associated with the presence and severity of CAD and are independent predictors of death and MI in patients with suspected or known CAD....

  6. Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6months follow-up.

    Science.gov (United States)

    Xia, Jinggang; Xu, Ji; Hu, Shaodong; Hao, Hengjian; Yin, Chunlin; Xu, Dong

    2017-08-01

    We explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. From May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. The occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85-5.38; P=0.01). The trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up. Copyright © 2017. Published by Elsevier B.V.

  7. Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China.

    Science.gov (United States)

    Li, Shenshen; Wu, Yangfeng; Du, Xin; Li, Xian; Patel, Anushka; Peterson, Eric D; Turnbull, Fiona; Lo, Serigne; Billot, Laurent; Laba, Tracey; Gao, Runlin

    2015-03-01

    Acute coronary syndromes (ACSs) are a major cause of morbidity and mortality, yet effective ACS treatments are frequently underused in clinical practice. Randomized trials including the CPACS-2 study suggest that quality improvement initiatives can increase the use of effective treatments, but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered randomized controlled trial. The CPACS-3 study is a stepped-wedge cluster-randomized trial conducted in 104 remote level 2 hospitals without PCI facilities in China. All hospitalized ACS patients will be recruited consecutively over a 30-month period to an anticipated total study population of more than 25,000 patients. After a 6-month baseline period, hospitals will be randomized to 1 of 4 groups, and a 6-component quality improvement intervention will be implemented sequentially in each group every 6months. These components include the following: establishment of a quality improvement team, implementation of a clinical pathway, training of physicians and nurses, hospital performance audit and feedback, online technical support, and patient education. All patients will be followed up for 6months postdischarge. The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality, myocardial infarction or reinfarction, and nonfatal stroke. The CPACS-3 study will be the first large randomized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes, in patients with ACS. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Climate-change driven increase in high intensity rainfall events: Analysis of development in the last decades and towards an extrapolation of future progression

    Science.gov (United States)

    Müller, Eva; Pfister, Angela; Gerd, Büger; Maik, Heistermann; Bronstert, Axel

    2015-04-01

    Hydrological extreme events can be triggered by rainfall on different spatiotemporal scales: river floods are typically caused by event durations of between hours and days, while urban flash floods as well as soil erosion or contaminant transport rather result from storms events of very short duration (minutes). Still, the analysis of climate change impacts on rainfall-induced extreme events is usually carried out using daily precipitation data at best. Trend analyses of extreme rainfall at sub-daily or even sub-hourly time scales are rare. In this contribution two lines of research are combined: first, we analyse sub-hourly rainfall data for several decades in three European regions.Second, we investigate the scaling behaviour of heavy short-term precipitation with temperature, i.e. the dependence of high intensity rainfall on the atmospheric temperature at that particular time and location. The trend analysis of high-resolution rainfall data shows for the first time that the frequency of short and intensive storm events in the temperate lowland regions in Germany has increased by up to 0.5 events per year over the last decades. I.e. this trend suggests that the occurrence of these types of storms have multiplied over only a few decades. Parallel to the changes in the rainfall regime, increases in the annual and seasonal average temperature and changes in the occurrence of circulation patterns responsible for the generation of high-intensity storms have been found. The analysis of temporally highly resolved rainfall records from three European regions further indicates that extreme precipitation events are more intense with warmer temperatures during the rainfall event. These observations follow partly the Clausius-Clapeyron relation. Based on this relation one may derive a general rule of maximum rainfall intensity associated to the event temperature, roughly following the Clausius-Clapeyron (CC) relation. This rule might be used for scenarios of future maximum

  9. [Risk management of coronary artery disease--pharmacological therapy].

    Science.gov (United States)

    Hofmann, Thomas

    2004-06-01

    Treatment of coronary artery disease primarily aims at reducing the severity and frequency of cardiac symptoms and improving prognosis. Both goals can be achieved by the administration of beta-receptor blockers, which are now used as first-line therapy in these patients. Calcium channel blockers or nitrates should be given in the event of contraindications or severe intolerance to beta-receptor blocking therapy. Only long-acting calcium channel blockers should be used in this setting. Another indication for additional treatment with calcium channel blockers and nitrates is given when the efficacy of beta-blocker therapy is not sufficient to relieve symptoms. Nitroglycerin and nitrates are the drugs of choice for the treatment of the acute angina pectoris attack. Calcium channel blockers are used as first-line treatment in patients with vasospastic angina. In patients with syndrome X, nitrates as well as calcium channel blockers or beta-receptor blockers can be administered. In the absence of contraindications, every patient with coronary artery disease should be given aspirin. A daily dosage of 75 to 150 mg is sufficient to reduce the rate of future cardiac events. Clopidogrel should be given in every patient with intolerance or contraindications for aspirin. Increased plasma homocystein levels seem to be a risk factor for coronary artery disease. Homocystein levels can be reduced by dietary means as well as supplementation of folic acid or vitamin B complex. There is no evidence from controlled randomised studies that a decrease of homocystein is beneficial for the prognosis of patients with coronary artery disease.

  10. Role of B-Type Natriuretic Peptide and N-Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

    DEFF Research Database (Denmark)

    Wolsk, Emil; Claggett, Brian; Pfeffer, Marc A

    2017-01-01

    -terminal prohormone B-type natriuretic peptide (NT-proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus. METHODS AND RESULTS: Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were...... being in death (0.77-0.82, Pdiabetes...

  11. Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Machado, Guilherme Pinheiro; Araujo, Gustavo Neves de; Carpes, Christian Kunde; Lech, Mateus; Mariani, Stefani; Valle, Felipe Homem; Bergoli, Luiz Carlos Corsetti; Gonçalves, Sandro Cadaval; Wainstein, Rodrigo V; Wainstein, Marco V

    2018-07-01

    Elevated neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are indirect inflammatory markers. There is some evidence that both are associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The aim of the present study was to compare the capacity of NLR and MPV to predict adverse events after primary PCI. In a prospective cohort study, 625 consecutive patients with STEMI, who underwent primary PCI, were followed. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for the occurrence of procedural complications, mortality and major adverse cardiovascular events (MACE). Mean age was 60.7 (±12.1) years, 67.5% were male. The median of NLR was 6.17 (3.8-9.4) and MPV was 10.7 (10.0-11.3). In multivariate analysis, both NLR and MPV remained independent predictors of no-reflow (relative risk [RR] = 2.26; 95%confidence interval [95%CI] = 1.16-4.32; p = 0.01 and RR = 2.68; 95%CI = 1.40-5.10; p  0.05). NLR had an excellent negative predictive value (NPV) of 96.7 for no-reflow and 89.0 for in-hospital MACE. Despite no difference in the ROC curve comparison with MPV, only NLR remained an independent predictor for in-hospital MACE. A low NLR has an excellent NPV for no-reflow and in-hospital MACE, and this could be of clinical relevance in the management of low-risk patients. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  13. Prognostic value of myocardial perfusion single-photon emission computed tomography for the prediction of future cardiac events in a Japanese population. A middle-term follow-up study

    International Nuclear Information System (INIS)

    Matsumoto, Naoya; Sato, Yuichi; Suzuki, Yasuyuki

    2007-01-01

    The prognostic value of rest 201 Tl/stress 99m Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) for the prediction of future hard cardiac events, including acute myocardial infarction (AMI), unstable angina (UAP) and cardiac death, and the implications for risk stratification has not yet been defined in a Japanese population. The 1,988 patients who underwent rest 201 Tl/stress 99m Tc-tetrofosmin SPECT were identified and followed up for the occurrence of AMI, UAP and cardiac death. The mean follow-up interval was 26.9±15.8 months. The 142 patients were revascularized within 60 days after SPECT and they were censored from the prognostic analysis. Summed stress score (SSS), summed rest score and summed difference score (SDS) were calculated using a 5-point scoring (Normal: 0, No uptake: 4) and a 20-segment model; 22 cases of myocardial infarction, 31 of UAP and 22 cardiac deaths occurred (1.2%, 1.7% and 1.2%, respectively). Multivariate Cox regression analysis showed that hypertension (Wald 6.37, p<0.05) and SDS (Wald 8.77, p<0.01) were independent predictors of AMI and UAP. Advanced age (Wald 16.0, p<0.001), SSS (Wald 10.9, p<0.01) and SDS (Wald 4.58, p<0.05) were independent predictors of cardiac death. Myocardial perfusion SPECT yields prognostic information toward the identification of acute coronary syndrome and cardiac death. (author)

  14. Effort–Reward Imbalance at Work and Incident Coronary Heart Disease

    Science.gov (United States)

    Siegrist, Johannes; Nyberg, Solja T.; Lunau, Thorsten; Fransson, Eleonor I.; Alfredsson, Lars; Bjorner, Jakob B.; Borritz, Marianne; Burr, Hermann; Erbel, Raimund; Fahlén, Göran; Goldberg, Marcel; Hamer, Mark; Heikkilä, Katriina; Jöckel, Karl-Heinz; Knutsson, Anders; Madsen, Ida E. H.; Nielsen, Martin L.; Nordin, Maria; Oksanen, Tuula; Pejtersen, Jan H.; Pentti, Jaana; Rugulies, Reiner; Salo, Paula; Schupp, Jürgen; Singh-Manoux, Archana; Steptoe, Andrew; Theorell, Töres; Vahtera, Jussi; Westerholm, Peter J. M.; Westerlund, Hugo; Virtanen, Marianna; Zins, Marie; Batty, G. David; Kivimäki, Mika

    2017-01-01

    Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease. Methods: This multicohort study (the “IPD-Work” consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort–reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis. Results: At baseline, 31.7% of study members reported effort–reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00–1.35) was observed for effort–reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01–1.34) for having either effort–reward imbalance or job strain and 1.41 (1.12–1.76) for having both these stressors compared to having neither effort–reward imbalance nor job strain. Conclusions: Individuals with effort–reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress. PMID:28570388

  15. Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study.

    Science.gov (United States)

    Schellekens, Mijntje M I; van Alebeek, Mayte E; Arntz, Renate M; Synhaeve, Nathalie E; Maaijwee, Noortje A M M; Schoonderwaldt, Hennie C; van der Vlugt, Maureen J; van Dijk, Ewoud J; Rutten-Jacobs, Loes C A; de Leeuw, Frank-Erik

    2018-05-01

    The role of hypercoagulable states and preceding infections in the etiology of young stroke and their role in developing recurrent ischemic events remains unclear. Our aim is to determine the prevalence of these conditions in patients with cryptogenic stroke at young age and to assess the long-term risk of recurrent ischemic events in patients with and without a hypercoagulable state or a recent pre-stroke infection with Borrelia or Syphilis. We prospectively included patients with a first-ever transient ischemic attack or ischemic stroke, aged 18-50, admitted to our hospital between 1995 and 2010. A retrospective analysis was conducted of prothrombotic factors and preceding infections. Outcome was recurrent ischemic events. Prevalence of prothrombotic factors did not significantly differ between patients with a cryptogenic stroke and with an identified cause (24/120 (20.0%) and 32/174 (18.4%) respectively). In patients with a cryptogenic stroke the long-term risk [mean follow-up of 8.9 years (SD 4.6)] of any recurrent ischemic event or recurrent cerebral ischemia did not significantly differ between patients with and without a hypercoagulable state or a recent infection. In patients with a cryptogenic stroke 15-years cumulative risk of any recurrent ischemic event was 24 and 23% in patients with and without any prothrombotic factor respectively. The prevalence of prothrombotic factors and preceding infections did not significantly differ between stroke patients with a cryptogenic versus an identified cause of stroke and neither is significantly associated with an increased risk of recurrent ischemic events after cryptogenic stroke.

  16. Abrupt climate change: Past, present and the search for precursors as an aid to predicting events in the future (Hans Oeschger Medal Lecture)

    Science.gov (United States)

    Mayewski, Paul Andrew

    2016-04-01

    the state of atmospheric circulation in the Southern Hemisphere that will result as a consequence of greenhouse gas rise and "healing" of the Antarctic ozone hole (Mayewski et al., 2015). Climate change perspective gained from instrumentally calibrated ice core and other past climate proxies is essential to the construction of plausible scenarios for future climate and actionable planning. More ACC events are in our future and the early manifestation of these events is apparent in the emerging change in the severity and frequency of extreme events. Searching for a precursor for ACC events is a major challenge for the scientific community and humanity. For the climate community to undertake this challenge it is necessary to investigate both past and present sub-seasonal and longer extreme events associated with past D-O and ACC events and their impact on societies. Examples of sub-seasonal scale investigation of these events will be included in the presentation. Mayewski, P.A., Sneed, S.B., Birkel, S.D., Kurbatov, A.V. and Maasch, Holocene warming marked by longer summers and reduced storm frequency around Greenland, Journal of Quaternary Science, 267-8179. DOl: I 0.1002/jqs.2684, 2013. Mayewski, P.A., Bertler, N., Birkel, S., Bracegirdle, T., Carleton, A., England, M., Goodwin, I., Kang, J-H., Mayewski, P., Russell, J., Schneider, S., Turner, J. and Vellicogna, I., 2015, Potential for Southern Hemisphere climate surprises, Journal of Quaternary Science (Rapid Communication) 30, 391-395, DOI: 10.1002/jqs.2794.

  17. Evolutionary paths, applications and future development of discrete event simulation systems; Simulazione a eventi discreti: nuove linee di sviluppo e applicazioni

    Energy Technology Data Exchange (ETDEWEB)

    Garetti, M. [Milan Politecnico, Milan (Italy). Dipt. di Economia e Produzione; Bartolotta, A.

    2000-10-01

    The state of the art of discrete event simulation tools is presented with special reference to the application to the manufacturing systems area. After presenting the basics of discrete event computer simulation, the different steps to be followed for the successful use of simulation are defined and discussed. The evolution of software packages for discrete event simulation is also presented, highlighting main technological changes. Finally the future development lines of simulation are outlined. [Italian] Viene presentato lo stato dell'arte della simulazione a eventi discreti. Dopo una breve descrizione della tecnica della simulazione e della sua evoluzione, con un particolare riguardo alla simulazione dei sistemi produttivi, sono descritte le fasi della procedura da seguire per condurre unostudio di simulazione e i possibili approcci per la costruzione del modello. Viene infine descritta l'evoluzione dei principali pacchetti software di simulazione esistenti sul mercato.

  18. Evidence of arterial wall uptake of fluorodeoxyglucose on imaging can indicate recent or future cardiovascular events in high-risk patients

    International Nuclear Information System (INIS)

    Paulmier, B.; Khayat, R.; Duet, M.; Pierquet-Ghazzar, N.; Maunoury, C.; Sauvaget, E.; Faraggi, M.; Laissy, J.P.

    2007-01-01

    With this study, we sought to identify plaque inflammation as assessed by 18 FDG uptake on positron emission tomography (PET)/computed tomography (CT) as an independent cardiovascular risk factor in patients at high risk for cardiovascular events. We compared 31 consecutive cancer patients presenting with visually enhanced 18 FDG uptake in arterial walls on PET/CT (Group 1) to a selection of 34 matched cancer patients not showing arterial uptake (Group 2). All patients were followed for two years before and six months after PET/CT... Cardiovascular events were classified as older (>6 months before PET/CT) or recent ( 18 FDG uptake was computed on non-attenuation corrected data by a AW/L ratio: mean Arterial Wall uptake/Lung uptake in a normal area, and by SUV on corrected data. A calcium score (CS) was also calculated. 18 FDG uptake and CS were higher in Group 1 than Group 2 (both p = 0.02), and older and recent cardiovascular events were significantly more frequent in Group 1 than Group 2 (p = 0.001 and p = 0.03. respectively). Among the following parameters: number of conventional risk factor, calcium score and presence of 18 FDG uptake, only the latter was significantly related to the occurrence of a recent event by multivariate analysis (p = 0.02). Patients with elevated arterial 18 FDG uptake have a high risk of immediate or future cardiovascular events. Arterial 18 FDG uptake is an indicator of evolving atherosclerotic process and can indicate future cardiovascular events. (authors)

  19. Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

    International Nuclear Information System (INIS)

    Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

    2013-01-01

    Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

  20. Foresight beyond the very next event: Four-year-olds can link past and deferred future episodes

    Directory of Open Access Journals (Sweden)

    Jonathan eRedshaw

    2013-07-01

    Full Text Available Previous experiments have demonstrated that by four years of age children can use information from a past episode to solve a problem for the very next future episode. However, it remained unclear whether four-year-olds can similarly use such information to solve a problem for a more removed future episode that is not of immediate concern. In the current study we introduced four-year-olds to problems in one room before taking them to another room and distracting them for 15 minutes. The children were then offered a choice of items to place into a bucket that was to be taken back to the first room when a five-minute sand-timer had completed a cycle. Across two conceptually distinct domains, the children placed the item that could solve the deferred future problem above chance level. This result demonstrates that by 48 months many children can recall a problem from the past and act in the present to solve that problem for a deferred future episode. We discuss implications for theories about the nature of episodic foresight.

  1. Nuclear cardiology in acute coronary syndromes

    International Nuclear Information System (INIS)

    Bulow, H.; Schwaiger, M.

    2005-01-01

    Acute coronary syndromes are a frequent manifestation of a coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of trier pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trails. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarcts avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application

  2. Imaging techniques in the diagnosis of coronary heart disease

    International Nuclear Information System (INIS)

    Frank, H.

    1997-01-01

    Coronary heart disease is the leading cause of death and disability worldwide. Coronary angiography makes it possible to visualize coronary artery stenosis and can be used for angioplasty and stent implantation; however, it does not allow the assessment of changes in myocardial microcirculation. The severity of an angiographically evaluated coronary stenosis does not always correspond to the extent of myocardial ischemia. Nonivasive techniques are needed to reexamine our reliance on coronary angiography and to explore the clinical value fo the physiological assessment of coronary artery stenoses. Such noninvasive techniques might become important tools in the future following an overal evaluation of coronary morphology, myocardial function and perfusion ascertained by all available methods. (orig.) [de

  3. After the flood is before the next flood - post event review of the Central European Floods of June 2013. Insights, recommendations and next steps for future flood prevention

    Science.gov (United States)

    Szoenyi, Michael; Mechler, Reinhard; McCallum, Ian

    2015-04-01

    In early June 2013, severe flooding hit Central and Eastern Europe, causing extensive damage, in particular along the Danube and Elbe main watersheds. The situation was particularly severe in Eastern Germany, Austria, Hungary and the Czech Republic. Based on the Post Event Review Capability (PERC) approach, developed by Zurich Insurance's Flood Resilience Program to provide independent review of large flood events, we examine what has worked well (best practice) and opportunities for further improvement. The PERC overall aims to thoroughly examine aspects of flood resilience, flood risk management and catastrophe intervention in order to help build back better after events and learn for future events. As our research from post event analyses shows a lot of losses are in fact avoidable by taking the right measures pre-event and these measures are economically - efficient with a return of 4 Euro on losses saved for every Euro invested in prevention on average (Wharton/IIASA flood resilience alliance paper on cost benefit analysis, Mechler et al. 2014) and up to 10 Euros for certain countries. For the 2013 flood events we provide analysis on the following aspects and in general identify a number of factors that worked in terms of reducing the loss and risk burden. 1. Understanding risk factors of the Central European Floods 2013 We review the precursors leading up to the floods in June, with an extremely wet May 2013 and an atypical V-b weather pattern that brought immense precipitation in a very short period to the watersheds of Elbe, Donau and partially the Rhine in the D-A-CH countries and researched what happened during the flood and why. Key questions we asked revolve around which protection and risk reduction approaches worked well and which did not, and why. 2. Insights and recommendations from the post event review The PERC identified a number of risk factors, which need attention if risk is to be reduced over time. • Yet another "100-year flood" - risk

  4. Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real-life cohort in Thailand

    Directory of Open Access Journals (Sweden)

    Chinwong D

    2015-04-01

    Full Text Available Dujrudee Chinwong,1,2 Jayanton Patumanond,3 Surarong Chinwong,1 Khanchai Siriwattana,4 Siriluck Gunaparn,5 John Joseph Hall,6 Arintaya Phrommintikul5 1Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 2Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; 4Division of Medicine, Nakornping Hospital, Chiang Mai, Thailand; 5Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 6Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia Background: Elevated low-density lipoprotein cholesterol (LDL-C is associated with an increased risk of cardiovascular disease or mortality; however, the LDL-C goal for therapy in acute coronary syndrome (ACS patients is controversial and varies among guidelines. This study aimed to assess the effect of reaching an LDL-C goal of <70 mg/dL (<1.8 mmol/L on first composite cardiovascular outcomes in routine clinical practice in Thailand.Methods: A retrospective cohort study was conducted using medical charts and the electronic hospital database of patients diagnosed with ACS and treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death. Cox proportional hazard models adjusted for potential confounders were used.Results: Of 405 patients, mean age was 65 years (60% males. Twenty-seven percent of the patients attained an LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL, and 35% had LDL-C ≥100 mg/dL. Forty-six patients experienced a composite

  5. Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

    Directory of Open Access Journals (Sweden)

    Bruno da Silva Matte

    2018-01-01

    Full Text Available We here report a case of ST-elevation myocardial infarction (STEMI due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel.

  6. Non-O blood groups can be a prognostic marker of in-hospital and long-term major adverse cardiovascular events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Aras, Dursun; Topaloglu, Serkan; Temizhan, Ahmet; Kisacik, Halil Lutfi; Aydogdu, Sinan

    2015-09-01

    Recent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) METHODS: 1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months. The prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 pblood group compared with O blood group (pblood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Future frequencies of extreme weather events in the National Wildlife Refuges of the conterminous U.S.

    Science.gov (United States)

    Martinuzzi, Sebastian; Allstadt, Andrew J.; Bateman, Brooke L.; Heglund, Patricia J.; Pidgeon, Anna M.; Thogmartin, Wayne E.; Vavrus, Stephen J.; Radeloff, Volker C.

    2016-01-01

    Climate change is a major challenge for managers of protected areas world-wide, and managers need information about future climate conditions within protected areas. Prior studies of climate change effects in protected areas have largely focused on average climatic conditions. However, extreme weather may have stronger effects on wildlife populations and habitats than changes in averages. Our goal was to quantify future changes in the frequency of extreme heat, drought, and false springs, during the avian breeding season, in 415 National Wildlife Refuges in the conterminous United States. We analyzed spatially detailed data on extreme weather frequencies during the historical period (1950–2005) and under different scenarios of future climate change by mid- and late-21st century. We found that all wildlife refuges will likely experience substantial changes in the frequencies of extreme weather, but the types of projected changes differed among refuges. Extreme heat is projected to increase dramatically in all wildlife refuges, whereas changes in droughts and false springs are projected to increase or decrease on a regional basis. Half of all wildlife refuges are projected to see increases in frequency (> 20% higher than the current rate) in at least two types of weather extremes by mid-century. Wildlife refuges in the Southwest and Pacific Southwest are projected to exhibit the fastest rates of change, and may deserve extra attention. Climate change adaptation strategies in protected areas, such as the U.S. wildlife refuges, may need to seriously consider future changes in extreme weather, including the considerable spatial variation of these changes.

  8. Feeling the future: A meta-analysis of 90 experiments on the anomalous anticipation of random future events [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Daryl Bem

    2016-01-01

    Full Text Available In 2011, one of the authors (DJB published a report of nine experiments in the Journal of Personality and Social Psychology purporting to demonstrate that an individual’s cognitive and affective responses can be influenced by randomly selected stimulus events that do not occur until after his or her responses have already been made and recorded, a generalized variant of the phenomenon traditionally denoted by the term precognition. To encourage replications, all materials needed to conduct them were made available on request. We here report a meta-analysis of 90 experiments from 33 laboratories in 14 countries which yielded an overall effect greater than 6 sigma, z = 6.40, p = 1.2 × 10-10  with an effect size (Hedges’ g of 0.09. A Bayesian analysis yielded a Bayes Factor of 5.1 × 109, greatly exceeding the criterion value of 100 for “decisive evidence” in support of the experimental hypothesis. When DJB’s original experiments are excluded, the combined effect size for replications by independent investigators is 0.06, z = 4.16, p = 1.1 × 10-5, and the BF value is 3,853, again exceeding the criterion for “decisive evidence.” The number of potentially unretrieved experiments required to reduce the overall effect size of the complete database to a trivial value of 0.01 is 544, and seven of eight additional statistical tests support the conclusion that the database is not significantly compromised by either selection bias or by intense “p-hacking”—the selective suppression of findings or analyses that failed to yield statistical significance. P-curve analysis, a recently introduced statistical technique, estimates the true effect size of the experiments to be 0.20 for the complete database and 0.24 for the independent replications, virtually identical to the effect size of DJB’s original experiments (0.22 and the closely related “presentiment” experiments (0.21. We discuss the controversial status of precognition and

  9. Feeling the future: A meta-analysis of 90 experiments on the anomalous anticipation of random future events [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Daryl Bem

    2015-10-01

    Full Text Available In 2011, one of the authors (DJB published a report of nine experiments in the Journal of Personality and Social Psychology purporting to demonstrate that an individual’s cognitive and affective responses can be influenced by randomly selected stimulus events that do not occur until after his or her responses have already been made and recorded, a generalized variant of the phenomenon traditionally denoted by the term precognition. To encourage replications, all materials needed to conduct them were made available on request. We here report a meta-analysis of 90 experiments from 33 laboratories in 14 countries which yielded an overall effect greater than 6 sigma, z = 6.40, p = 1.2 × 10-10  with an effect size (Hedges’ g of 0.09. A Bayesian analysis yielded a Bayes Factor of 1.4 × 109, greatly exceeding the criterion value of 100 for “decisive evidence” in support of the experimental hypothesis. When DJB’s original experiments are excluded, the combined effect size for replications by independent investigators is 0.06, z = 4.16, p = 1.1 × 10-5, and the BF value is 3,853, again exceeding the criterion for “decisive evidence.” The number of potentially unretrieved experiments required to reduce the overall effect size of the complete database to a trivial value of 0.01 is 544, and seven of eight additional statistical tests support the conclusion that the database is not significantly compromised by either selection bias or by “p-hacking”—the selective suppression of findings or analyses that failed to yield statistical significance. P-curve analysis, a recently introduced statistical technique, estimates the true effect size of our database to be 0.20, virtually identical to the effect size of DJB’s original experiments (0.22 and the closely related “presentiment” experiments (0.21. We discuss the controversial status of precognition and other anomalous effects collectively known as psi.

  10. Noninvasive detection of coronary artery disease: challenges for prevention of disease and clinical events Métodos não invasivos para identificação da doença aterosclerótica: desafios para prevenção da doença e eventos clínicos

    Directory of Open Access Journals (Sweden)

    Protásio Lemos da Luz

    2005-10-01

    Full Text Available Atherosclerosis is a chronic inflammatory disease that affects essentially all arterial beds including the aorta, coronaries, carotids, and peripheral arteries. It is the main cause of death in the western hemisphere, due to cardiovascular syndromes such as myocardial infarction, heart failure, and cerebrovascular accidents. Very substantial economic and human resources have been used on treatments of its complications, including imaging studies, coronary bypass surgery, catheter interventions, pacemakers, and medical treatments. Treating complications, however, are remedial actions. A better alternative is to prevent the development of atherosclerosis, or at least to identify patients who are at risk of acute events and intervene before they occur. The aims of this review are to discuss the predictive value of traditional and emerging risk factors, as well as the role of noninvasive diagnostic methods for coronary atherosclerosis, including exercise stress test, echo stress test, duplex ultrasound, computed tomography, and magnetic resonance. A combination of serum biomarkers and noninvasive approaches is of practical utility for identifying early disease. It is to be expected that future developments will soon perfect our ability to identify the vulnerable patient and allow a more individualized approach.A aterosclerose é uma doença inflamatória crônica que afeta essencialmente todas as artérias incluindo a aorta, coronárias, carótidas e artérias periféricas. É a causa principal de morte no hemisfério ocidental, devido as síndromes cardiovasculares, tais como o infarto do miocárdio, insuficiência cardíaca e acidentes cerebrovasculares. Quantidades enormes de recursos econômicos e humanos são usadas em tratamentos de suas complicações, inclusive estudos de imagem, cirurgias coronárias, intervenções com cateteres, marcapasso e tratamentos médicos. Tratar complicações, entretanto, são ações a posteriori. Uma

  11. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis.

    Science.gov (United States)

    Yetkin, Ertan; Topal, Ergun; Erguzel, Nuri; Senen, Kubilay; Heper, Gulumser; Waltenberger, Johannes

    2015-04-01

    Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery. The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group. Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p risk factor for poor CVD in addition to DM in patients with CTO.

  12. Development of Coronary Pulse Wave Velocity: New Pathophysiological Insight Into Coronary Artery Disease.

    Science.gov (United States)

    Harbaoui, Brahim; Courand, Pierre-Yves; Cividjian, Andrei; Lantelme, Pierre

    2017-02-02

    Although aortic stiffness assessed by pulse wave velocity (PWV) is a strong predictor of coronary artery disease, the significance of local coronary stiffness has never been tackled. The first objective of this study was to describe a method of measuring coronary PWV (CoPWV) invasively and to describe its determinants. The second objective was to assess both CoPWV and aortic PWV in patients presenting with acute coronary syndromes or stable coronary artery disease. In 53 patients, CoPWV was measured from the delay in pressure wave and distance traveled as a pressure wire was withdrawn from the distal to the proximal coronary segment. Similarly, aortic PWV was measured invasively when the wire was pulled across the ascending aorta; carotid-femoral PWV was also measured noninvasively using the SphygmoCor system (AtCor Medical). Mean CoPWV was 10.3±6.1 m/s. Determinants of increased CoPWV were fractional flow reserve, diastolic blood pressure, and previous stent implantation in the recorded artery. CoPWV was lower in patients with acute coronary syndromes versus stable coronary artery disease (7.6±3 versus 11.5±6.4 m/s; P=0.02), and this persisted after adjustment for confounders. In contrast, aortic stiffness, assessed by aortic and carotid-femoral PWV, did not differ significantly. CoPWV seems associated with acute coronary events more closely than aortic PWV. High coronary compliance, whether per se or because it leads to a distal shift in compliance mismatch, may expose vulnerable plaques to high cyclic stretch. CoPWV is a new tool to assess local compliance at the coronary level; it paves the way for a new field of research. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. Sequential Vein Bypass Grafting is Not Associated with an Increase of Either In-hospital or Mid-term Adverse Events in Off-pump Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Fucheng Xiao

    2015-01-01

    Full Text Available Background: The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG. We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG. Methods: From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI, stroke, requirement for intra-aortic ballon pump (IABP assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization and angina recurrence were considered as mid-term endpoints. Results: No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001. There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45. Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36 and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48 were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence. Conclusions: Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in

  14. Comparison of a Simple Angiographic Approach With a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery Score-Based Approach for Left Main Coronary Artery Stenting: A Pooled Analysis of Serial PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) Studies.

    Science.gov (United States)

    Lee, Pil Hyung; Lee, Jong-Young; Lee, Cheol Whan; Kim, Seon-Ok; Ahn, Jung-Min; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Park, Seung-Jung

    2018-01-01

    The applicability of Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores to left main coronary artery disease (CAD) has been questioned. A simplified alternative is needed for guiding decision making. We evaluated the prognostic value of a simplified angiographic classification in comparison with a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score-based approach for patients with left main CAD undergoing drug-eluting stent implantation. The proposed approach classified left main CAD as either extensive (n=819), defined as left main bifurcation lesions with an involvement of ostial left circumflex artery or as any left main lesion plus multivessel CAD, or limited (n=453), defined as ostial/midshaft lesions or left main bifurcation lesions without an involvement of ostium of left circumflex artery, alone or plus 1-vessel disease. The databases from 4 prospective Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease studies were pooled, and the primary outcome was a major adverse cardiac event, defined as death, myocardial infarction, or repeat revascularization. During follow-up (median 38 months; interquartile range, 36-61 months), the risk for major adverse cardiac event was significantly higher with extensive than with limited left main CAD (adjusted hazard ratio, 2.13; 95% confidence interval, 1.54-2.94; P Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score tertiles did not effectively stratify these 2 outcome measures. Compared with Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores, the simpler angiographic approach provided better discrimination for future cardiovascular events in patients with left main CAD undergoing drug-eluting stent implantation. © 2018 American Heart Association, Inc.

  15. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

  16. The past and the future of Alzheimer’s disease CSF biomarkers – a journey towards validated biochemical tests covering the whole spectra of molecular events

    Directory of Open Access Journals (Sweden)

    Kaj eBlennow

    2015-09-01

    Full Text Available This paper gives a short review on cerebrospinal fluid (CSF biomarkers for Alzheimer’s disease (AD, from early developments to high-precision validated assays on fully automated lab analyzers. We also discuss developments on novel biomarkers, such as synaptic proteins and Aβ oligomers. Our vision for the future is that assaying a set of biomarkers in a single CSF tube can monitor the whole spectra of AD molecular pathogenic events. CSF biomarkers will have a central position not only for clinical diagnosis, but also for the understanding of the sequence of molecular events in the pathogenic process underlying AD and as tools to monitor the effects of novel drug candidates targeting these different mechanisms.

  17. The role of levosimendan in acute heart failure complicating acute coronary syndrome

    DEFF Research Database (Denmark)

    Nieminen, Markku S; Buerke, M.; Cohen-Solal, A.

    2016-01-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently bee...

  18. Elevated oxidative stress among coronary artery disease patients on statin therapy: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Sabitha Palazhy

    2015-05-01

    Conclusions: Though coronary artery disease subjects had healthy lipid profile, oxidative stress, a recognized risk factor for coronary events, was still elevated among this patient group. Novel risk factors were not found to be major predictors for coronary artery disease among the study subjects.

  19. Prolonged corrected QT interval is predictive of future stroke events even in subjects without ECG-diagnosed left ventricular hypertrophy.

    Science.gov (United States)

    Ishikawa, Joji; Ishikawa, Shizukiyo; Kario, Kazuomi

    2015-03-01

    We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (≥440 ms in men and ≥460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, ≥244 mV×ms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7±28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population. © 2014 American Heart Association, Inc.

  20. Prediction of acute coronary syndromes by urinary proteome analysis.

    Directory of Open Access Journals (Sweden)

    Nay M Htun

    Full Text Available Identification of individuals who are at risk of suffering from acute coronary syndromes (ACS may allow to introduce preventative measures. We aimed to identify ACS-related urinary peptides, that combined as a pattern can be used as prognostic biomarker. Proteomic data of 252 individuals enrolled in four prospective studies from Australia, Europe and North America were analyzed. 126 of these had suffered from ACS within a period of up to 5 years post urine sampling (cases. Proteomic analysis of 84 cases and 84 matched controls resulted in the discovery of 75 ACS-related urinary peptides. Combining these to a peptide pattern, we established a prognostic biomarker named Acute Coronary Syndrome Predictor 75 (ACSP75. ACSP75 demonstrated reasonable prognostic discrimination (c-statistic = 0.664, which was similar to Framingham risk scoring (c-statistics = 0.644 in a validation cohort of 42 cases and 42 controls. However, generating by a composite algorithm named Acute Coronary Syndrome Composite Predictor (ACSCP, combining the biomarker pattern ACSP75 with the previously established urinary proteomic biomarker CAD238 characterizing coronary artery disease as the underlying aetiology, and age as a risk factor, further improved discrimination (c-statistic = 0.751 resulting in an added prognostic value over Framingham risk scoring expressed by an integrated discrimination improvement of 0.273 ± 0.048 (P < 0.0001 and net reclassification improvement of 0.405 ± 0.113 (P = 0.0007. In conclusion, we demonstrate that urinary peptide biomarkers have the potential to predict future ACS events in asymptomatic patients. Further large scale studies are warranted to determine the role of urinary biomarkers in clinical practice.

  1. Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring.

    Science.gov (United States)

    Liew, Gary; Chow, Clara; van Pelt, Niels; Younger, John; Jelinek, Michael; Chan, Jonathan; Hamilton-Craig, Christian

    2017-12-01

    Coronary Artery Calcium Scoring (CAC) is a non-invasive quantitation of coronary artery calcification using computed tomography (CT). It is a marker of atherosclerotic plaque burden and an independent predictor of future myocardial infarction and mortality. Coronary Artery Calcium Scoring provides incremental risk information beyond traditional risk calculators (eg. Framingham Risk Score). Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as "individualised coronary risk scoring" for those not considered to be of high or low risk. Medical practitioners should carefully counsel patients prior to CAC. Coronary Artery Calcium Scoring should only be undertaken if an alteration in therapy including embarking on pharmacotherapy is being considered based on the test result. Patient Groups to Consider Coronary Calcium Scoring: Patient Groups in Whom Coronary Calcium Scoring Should Not be Considered: Coronary Artery Calcium Scoring is not recommended for patients who are: Interpretation of CAC CAC=0 A zero score confers a very low risk of death, 75th centile. Moderately high risk, 15-20% CAC >400 High risk, >20% Management Recommendations Based on CAC Optimal diet and lifestyle measures are encouraged in all risk groups and form the basis of primary prevention strategies. Patients with moderately-high or high risk based on CAC score are recommended to receive preventative medical therapy such as aspirin and statins. The evidence for pharmacotherapy is less robust in patients at intermediate levels of CAC 100-400, with modest benefit for aspirin use; though statins may be reasonable if they are above 75th centile. Aspirin and statins are generally not recommended in patients with CAC calcium score, routine re-scanning is not currently recommended. However, an annual increase in CAC of >15% or annual increase of CAC >100 units are predictive of future myocardial infarction and mortality. Cost Effectiveness of CAC

  2. Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.

    Science.gov (United States)

    Dragano, Nico; Siegrist, Johannes; Nyberg, Solja T; Lunau, Thorsten; Fransson, Eleonor I; Alfredsson, Lars; Bjorner, Jakob B; Borritz, Marianne; Burr, Hermann; Erbel, Raimund; Fahlén, Göran; Goldberg, Marcel; Hamer, Mark; Heikkilä, Katriina; Jöckel, Karl-Heinz; Knutsson, Anders; Madsen, Ida E H; Nielsen, Martin L; Nordin, Maria; Oksanen, Tuula; Pejtersen, Jan H; Pentti, Jaana; Rugulies, Reiner; Salo, Paula; Schupp, Jürgen; Singh-Manoux, Archana; Steptoe, Andrew; Theorell, Töres; Vahtera, Jussi; Westerholm, Peter J M; Westerlund, Hugo; Virtanen, Marianna; Zins, Marie; Batty, G David; Kivimäki, Mika

    2017-07-01

    Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease. This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis. At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain. Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  3. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

    Science.gov (United States)

    Fabris, Enrico; van 't Hof, Arnoud; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens F; Goodman, Shaun G; Ten Berg, Jurriën M; Bolognese, Leonardo; Cequier, Angel; Chettibi, Mohamed; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Merkely, Béla; Storey, Robert F; Zeymer, Uwe; Cantor, Warren J; Tsatsaris, Anne; Kerneis, Mathieu; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles

    2017-08-01

    In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; pST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; pST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

  4. Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial [NCT01159639

    Directory of Open Access Journals (Sweden)

    Gasparovic Hrvoje

    2012-08-01

    Full Text Available Abstract Background Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive. The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. Methods Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology as well as bleeding events will be recorded. Discussion This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management. This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639.

  5. Remote clinical prognosis in patients with coronary X syndrome

    Directory of Open Access Journals (Sweden)

    Sebov D.M.

    2015-09-01

    Full Text Available The article analyzes data of 3234 coronary angiographies with established coronary X syndrome (CXS in 217 cases, herewith expressed tortuosity of coronary arteries (ETCA was found out in 148 (more than 2/3 of cases. A 5-years’ analysis of cardio-vascular events (CVE in patients with CXS in comparison with the group of IHD patients and initial atherosclerosis of coronary arteries was made. Absence of reliable difference of developing severe cardio-vascular events (SCVE bet¬ween patients with initial atherosclerosis and CXS was proved. Risk of CVE development was significantey higher in patients with ETCA, OR=4,93; 95% (0,62; 3929. Patients with CXS had higher risk of severe arrhythmias development as compared with IHD patients with initial atherosclerosis: OR=2,36 (1,01; 5,56. There was no reliable difference between lethality of any causes and number of coronary interventions in all groups.

  6. Morphological study on coronary ostial and clinicoangiographic analysis of isolated coronary ostial stenosis

    International Nuclear Information System (INIS)

    Kanoh, Tatsuji

    2007-01-01

    A morphological study of coronary ostia was performed in 70 autopsied human hearts, with particular attention being focused on the funnel-shaped structure, aging changes, and relation to atherosclerosis. The following results were obtained: The ostium is particularly well-defined and forms a funnel-shaped structure. The structure is predominantly a double circular shape on the right and comet-shaped on the left. The funnel-shaped structure of coronary ostia is characterized by a longitudinal smooth muscle arrangement in the inner layer and circular one in the outer layer. Including overhang formation, coronary sclerosis of the ostium appears mainly on the upper margin of the funnel-shaped structure of the right ostium and at the upper right margin of the left. In ischemic heart disease, along with changes in coronary arteries themselves, changes in the ostia of these arteries should be paid close attention. Ostial stenosis of the coronary artery in the absence of distal vessel obstructions, isolated ostial stenosis, is a rare form of coronary artery disease. In a previous review of the international literature, the incidence of coronary ostial stenosis varied between 0.13% and 2.7%. Among 7,500 patients undergoing selective coronary cineangiography at Juntendo University Hospital and Juntendo Urayasu Hospital from 1975 to 1990, five women (0.07%) were diagnosed as having ''isolated coronary ostial stenosis'', of which the cause is unknown. Atherosclerosis, particularly early premature atherome, congenital coronary anomaly, fibro-muscular dysplasia, Takayasu's aortitis, humoral factors, spasm, and iatrogenic events have been considered as its causes. In contrast to usual atherosclerotic coronary artery disease, patients with isolated coronary ostial stenosis of unknown etiology were characterized as being middle-aged, premenopausal, slender females having few coronary risk factors, experiencing severe angina pector is with marked ischemic electrocardiogram changes

  7. Simulation of coastal floodings during a typhoon event with the consideration of future sea-level rises.

    Science.gov (United States)

    Shu-Huei, Jhang; Chih-Chung, Wen; Dong-Jiing, Doong; Cheng-Han, Tsai

    2017-04-01

    Taiwan is an Island in the western Pacific Ocean and experienced more than 3 typhoons in a year. Typhoons bring intense rainfall, high waves, and storm surges, which often resulted in coastal flooding. The flooding can be aggravated by the sea level rise due to the global warming, which may subject Taiwan's coastal areas to more serious damage in the future than present. The objectives of this study are to investigate the flooding caused by typhoons in the Annan District, Tainan, a city on the southwest coast of Taiwan by numerical simulations, considering the effects of sea-level rises according to the level suggested by the 5th Assessment Report of IPCC (Intergovernmental Panel on Climate Change) for 2050 and 2100, respectively. The simulations were carried out by using MIKE21 HD (a hydrodynamic model) and MIKE21 SW (a spectral wave model). In our simulation, we used an intense typhoon, named Soudelor, as our base typhoon, which made its landfall on the east coast of Taiwan in the summer of 2015, traveled through the width of the island, and exited the island to the north of Tainan. The reasons we pick this typhoon are that it passed near our objective area, wind field data for this typhoon are available, and we have well documented coastal wave and water level measurements during the passage of Typhoon Soudelor. We firstly used ECMWF (European Centre for Medium-Range Weather Forecasts) wind field data to reconstruct typhoon waves and storm surges for this typhoon by using coupled MIKE21 SW and MIKE21 HD in a regional model. The resultant simulated wave height and sea-level height matched satisfactorily with the measured data. The wave height and storm surge calculated by the regional model provided the boundary conditions for our fine-grid domain. Then different sea-level rises suggested by the IPCC were incorporated into the fine-grid model. Since river discharge due to intense rainfall has also to be considered for coastal flooding, our fine-grid models

  8. Excessive Daytime Sleepiness is Associated with Longer Culprit Lesion and Adverse Outcomes in Patients with Coronary Artery Disease

    Science.gov (United States)

    Lee, Chi-Hang; Ng, Wai-Yee; Hau, William; Ho, Hee-Hwa; Tai, Bee-Choo; Chan, Mark Y.; Richards, A. Mark; Tan, Huay-Cheem

    2013-01-01

    Study Objectives: We assessed whether excessive daytime sleepiness was associated with coronary plaque phenotype and subsequent adverse cardiovascular events. Methods: Prospective cohort study. Intravascular ultrasound (IVUS) examination of the culprit coronary stenosis was performed. The Epworth Sleepiness Scale (ESS) questionnaire was administered, and the patients were divided into 2 groups—(1) sleepier and (2) less sleepy—based on the ESS score. Adverse cardiovascular outcomes were defined as cardiac death, myocardial infarction, stroke, unplanned revascularization, or heart failure admission. Results: One hundred seventeen patients undergoing urgent or non-urgent coronary angiography were recruited. Compared with the less sleepy group (ESS ≤ 10, n = 87), the sleepier group (ESS > 10, n = 30) had higher serum levels of total cholesterol and of low-density-lipoprotein cholesterols (p 10 was associated with longer culprit lesions and future adverse cardiovascular events. Citation: Lee CH; Ng WY; Hau W; Ho HH; Tai BC; Chan MY; Richards AM; Tan HC. Excessive daytime sleepiness is associated with longer culprit lesion and adverse outcomes in patients with coronary artery disease. J Clin Sleep Med 2013;9(12):1267-1272. PMID:24340288

  9. Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography

    International Nuclear Information System (INIS)

    Shabestari, Abbas Arjmand; Akhlaghpoor, Shahram; Tayebivaljozi, Reza; Fattahi Masrour, Farzaneh

    2012-01-01

    Coronary artery anomalies are not common, but could be very serious. This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT). The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists. Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%). Eighty-three subjects (3.1%) showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA) were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA), left circumflex artery (LCx), left anterior descending artery (LAD), posterior descending artery (PDA) and obtuse marginal (OM) artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%. Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging

  10. Ethnic variations in acute coronary syndromes

    OpenAIRE

    Lanza, G A

    2004-01-01

    Although it is very likely that ethnic variations in the incidence and, possibly, clinical outcome of acute coronary artery disease events exist, the causes for such differences are many and difficult to address fully, given the complex interplay of contributing factors

  11. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. Methods and Results Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

  12. Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography

    Directory of Open Access Journals (Sweden)

    W.C. Manfroi

    1999-03-01

    Full Text Available Many clinical and epidemiological studies have demonstrated the relationship between serum ferritin and ischemic heart disease. In the present study we evaluated the relationship between coronary heart disease (CHD and serum ferritin levels in patients submitted to coronary arteriography. We evaluated 307 patients (210 (68.7% males; median age: 60 years who were submitted to coronary angiography, measurement of serum ferritin and identification of clinical events of ischemic heart disease. Serum ferritin is reported as quartiles. Ninety-six patients (31.27% had normal coronary angiography (group 1 and 211 (68.73% had coronary heart disease (group 2. Of the patients with CHD, 61 (28.9% had serum ferritin levels higher than 194 ng/ml (4th quartile, as opposed to only 14 (14.58% of those without CHD (P = 0.0067. In the 2nd quartile, 39 patients (18.48% had CHD, while 35 patients (36.46% had normal coronary arteries (P = 0.00064. Multivariate analysis of the data showed that the difference between groups was not statistically significant (P = 0.33. We conclude that there is no independent relationship between coronary heart disease and increased levels of serum ferritin.

  13. Additive prognostic value of plasma N-terminal pro-brain natriuretic peptide and coronary artery calcification for cardiovascular events and mortality in asymptomatic patients with type 2 diabetes

    DEFF Research Database (Denmark)

    von Scholten, Bernt Johan; Reinhard, Henrik; Hansen, Tine Willum

    2015-01-01

    BACKGROUND: In patients with type 2 diabetes, cardiovascular disease (CVD) is the major cause of morbidity and mortality. We evaluated the combination of NT-proBNP and coronary artery calcium score (CAC) for prediction of combined fatal and non-fatal CVD and mortality in patients with type 2 diab...

  14. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX – RAdiation Dose study (RAD-MATRIX)

    International Nuclear Information System (INIS)

    Sciahbasi, Alessandro; Calabrò, Paolo; Sarandrea, Alessandro; Rigattieri, Stefano; Tomassini, Francesco; Sardella, Gennaro; Zavalloni, Dennis; Cortese, Bernardo; Limbruno, Ugo; Tebaldi, Matteo; Gagnor, Andrea; Rubartelli, Paolo; Zingarelli, Antonio; Valgimigli, Marco

    2014-01-01

    Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. Conclusions: The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes

  15. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX – RAdiation Dose study (RAD-MATRIX)

    Energy Technology Data Exchange (ETDEWEB)

    Sciahbasi, Alessandro, E-mail: alessandro.sciahbasi@fastwebnet.it [Interventional Cardiology, Sandro Pertini Hospital – ASL RMB, Rome (Italy); Calabrò, Paolo [Division of Cardiology - Department of Cardio-Thoracic Sciences - Second University of Naples (Italy); Sarandrea, Alessandro [HSE Management, Rome (Italy); Rigattieri, Stefano [Interventional Cardiology, Sandro Pertini Hospital – ASL RMB, Rome (Italy); Tomassini, Francesco [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Sardella, Gennaro [La Sapienza University, Rome (Italy); Zavalloni, Dennis [UO Emodinamica e Cardiologia Invasiva, IRCCS, Istituto Clinico Humanitas, Rozzano (Italy); Cortese, Bernardo [Interventional Cardiology, Fatebenefratelli Hospital, Milan (Italy); Limbruno, Ugo [Cardiology Unit, Misericordia Hospital, Grosseto (Italy); Tebaldi, Matteo [Cardiology Department, University of Ferrara, Department of Cardiology (Italy); Gagnor, Andrea [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Rubartelli, Paolo [Villa Scassi Hospital, Genova (Italy); Zingarelli, Antonio [San Martino Hospital, Genova (Italy); Valgimigli, Marco [Thoraxcenter, Rotterdam (Netherlands)

    2014-06-15

    Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. Conclusions: The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes.

  16. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX - RAdiation Dose study (RAD-MATRIX).

    Science.gov (United States)

    Sciahbasi, Alessandro; Calabrò, Paolo; Sarandrea, Alessandro; Rigattieri, Stefano; Tomassini, Francesco; Sardella, Gennaro; Zavalloni, Dennis; Cortese, Bernardo; Limbruno, Ugo; Tebaldi, Matteo; Gagnor, Andrea; Rubartelli, Paolo; Zingarelli, Antonio; Valgimigli, Marco

    2014-06-01

    Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  18. Prognostic factors of male patients with acute coronary syndrome after percutaneous coronary intervention therapy

    International Nuclear Information System (INIS)

    Xu Peng; Zhang Gaofeng; Wu Xusheng; Qiao Qi; Yu Liqun

    2005-01-01

    Objective: To study the prognostic risk factors of male patients with coronary heart disease in stent placement era. Methods: One hundred and four patients were enrolled in this study (aged 64.9 ± 9.6 years) including 61 diagnosed as acute myocardial infarction, and 43 as unstable angina with followed up 11.9 ± 8.7 months. All factors including demographic factors, non-interventional work-up, associated clinical complications and results of coronary artery angiography reached a model of Logistic regression analysis. Results: Based on MACE (major adverse cardiac events), as quantitative factors, diseased proximal middle left anterior descending artery was a significant independent variable (P<0.05), and its coefficient was 22.00. Conclusions: Diseased proximal middle left anterior descending coronary artery is the prognostic factor of MACE in male patients with acute coronary syndrome. (authors)

  19. The role of Homocysteine as a predictor for coronary heart disease

    Directory of Open Access Journals (Sweden)

    Schramm, Susanne

    2007-11-01

    analyse the association of homocysteine plasma levels with future cardiac events in probands without pre-existing coronary heart disease or in population-based samples. To answer the second question, a systematic overview of the literature is prepared, including randomised controlled trials and systematic reviews of randomised controlled trials that determine the effectiveness of homocysteine lowering therapy for the prevention of cardiac events. To answer the third question, economic evaluations of homocysteine testing for preventive purposes are analysed. Methodological quality of all materials is assessed by widely accepted instruments, evidence was summarized qualitatively. Results: For the first question eleven systematic reviews and 33 single studies (prospective cohort studies and nested case control studies are available. Among the studies there is profound heterogeneity concercing study populations, classification of exposure (homocysteine measurements, units to express “elevation”, outcome definition and measurement, as well as controlling for confounding (qualitatively and quantitatively. Taking these heterogeneities into consideration, metaanalysis of single patient data with controlling for multiple confounders seems to be the only adequate method of summarizing the results of single studies. The only available analysis of this type shows, that in otherwise healthy people homocysteine plasma levels are only a very weak predictor of future cardiac events. The predictive value of the classical risk factors is much stronger. Among the studies that actively exclude patients with pre-existing coronary heart disease, there are no reports of an association between elevated homocysteine plasma levels and future cardiac events. Eleven randomized controlled trials (ten of them reported in one systematic review are analysed in order to answer the second question. All trials include high risk populations for the development of (further cardiac events. These studies

  20. SENTINEL EVENTS

    Directory of Open Access Journals (Sweden)

    Andrej Robida

    2004-09-01

    the surveyed persons agreed to disclosure of the event to a patient but this was the case in less than half of the occasions.Conclusions. The small number of reports of sentinel events, late or incomplete reporting of conducted analyses of root causes and plans for future prevention of these events and survey data showed the state of culture in the majority of hospitals. Fear of reporting and therefore, hiding of errors or ascribing errors to the »usual« complications of a disease or procedures, the reaction of leadership to quickly find a culprit for the event, disregarding a serious approach to analyze the event and taking measures for their future prevention leads to the culture of silence. Root cause analysis of the events showed that the reason frequently lies in systems and processes and not in individuals. Health care will never be without risks for patients. However, with an open approach without the blaming and shaming of individuals, implementation of reporting the events in hospitals and other health care facilities with clear goals of patient safety, standardization of equipment, materials, and processes and education on patient safety many sentinel events and medical errors could and should be prevented.

  1. Evaluation of myocardial bridging by coronary computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Rabelo, Daniel Rocha; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil); Garretto, Luiza Samarane; Paula, Marcela Mascarenhas De; Carvalho, Marina Oliveira; Alves, Marina Rangel Moreira Barros [Faculdade de Saude e Ecologia Humana (FASEH), Vespasiano, MG (Brazil)

    2013-01-15

    The myocardial bridge (MB) is defined as a segment of an epicardial coronary artery that has an intramural course in the myocardium. Although MB is clinically silent in most cases, has been associated with myocardial ischemia, arrhythmias and sudden death. Coronary conventional angiography is the gold standard for detection of MB, but is invasive and cannot be sufficiently sensitive compared to autopsy studies. Recently, multislice computed tomography of coronary arteries (MCTCA) has allowed the detection of coronary artery course, including PM. Objectives: to evaluate MB prevalence in patients with suspected coronary artery disease undergoing MCTCA and to evaluate the predictive value of this method at medium term. Methods: during the period 2008 to 2011, 498 consecutive patients were examined by TMC for the diagnosis of coronary artery disease, being conducted to evaluate the presence of BM and followed for a mean follow-up of 23 months for the occurrence of cardiovascular hard events (death, hospitalization or revascularization). Results: patients mean age was 55.3 ± 14.2, being male 71.1%. Among the patients, 7.6% (38 patients) showed MB. Main findings included angina pectoris in 40% and a positive stress test in 34%. 34.2% had atherosclerotic disease, and one patient had significant coronary stenosis. During follow-up, no patients showed adverse events. Conclusion: MCTCA is a noninvasive technique with high accuracy in anatomical evaluation of the coronary arteries and may be particularly useful to assess the incidence, location and morphology of myocardial bridging in vivo. (author)

  2. Prognostic value and limitations of exercise radionuclide angiography in medically treated coronary artery disease

    International Nuclear Information System (INIS)

    Taliercio, C.P.; Clements, I.P.; Zinsmeister, A.R.; Gibbons, R.J.

    1988-01-01

    We investigated whether exercise radionuclide angiography provides prognostic information in addition to that identified by resting left ventricular function and coronary anatomy in patients with medically treated coronary artery disease. Clinical follow-up (median, 21.7 months) was obtained in 424 medically treated patients who underwent exercise radionuclide angiography and coronary angiography. The mean age of the study population was 58 years, and 67% were men. Cardiac death occurred in 16 patients, nonfatal myocardial infarction in 16, and nonfatal out-of-hospital cardiac arrest in 1. Univariate analysis showed that multiple variables were associated with future cardiac events, including number of diseased vessels, exercise and rest radionuclide ejection fraction, history of myocardial infarction, exercise and rest left ventricular end-systolic and end-diastolic volume indices, peak exercise workload, age, abnormal resting electrocardiogram, and peak exercise ST-segment depression. Only three variables were independently associated with cardiac events on follow-up: number of diseased vessels, radionuclide ejection fraction at rest, and age. In patients with three-vessel disease and a resting radionuclide ejection fraction of more than 40%, a subgroup with higher risk could not be identified on the basis of exercise radionuclide response

  3. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  4. Indications for coronary angiography

    International Nuclear Information System (INIS)

    Kaltenbach, M.; Vallbracht, C.

    1985-01-01

    Today selective coronary angiography, introduced by Sones in 1957, is used as clinical routine for diagnosing morphological changes in the coronary arteries. Hitherto, more recent techniques such as digital subtraction angiography cannot provide comparable information. Strict criteria for its indication depending on possible therapeutic consequences, have to be applied, although the risk is low with a letality of 0.01 to 0.05 percent. Radionuclear investigations can be used as additional tool in selected cases. The careful indication for coronary angiography usually implies the possible need for coronary bypass graft surgery of balloon angioplasty. (orig./MG) [de

  5. Patient-rated health status predicts prognosis following percutaneous coronary intervention with drug-eluting stenting

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Versteeg, Henneke; Denollet, Johan

    2011-01-01

    In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events.......In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events....

  6. Regulation of Coronary Blood Flow in Health and Ischemic Heart Disease

    Science.gov (United States)

    Duncker, Dirk J.; Koller, Akos; Merkus, Daphne; Canty, John M.

    2018-01-01

    The major factors determining myocardial perfusion and oxygen delivery have been elucidated over the past several decades, and this knowledge has been incorporated into the management of patients with ischemic heart disease (IHD). The basic understanding of the fluid mechanical behavior of coronary stenoses has also been translated to the cardiac catheterization laboratory where measurements of coronary pressure distal to a stenosis and coronary flow are routinely obtained. However, the role of perturbations in coronary microvascular structure and function, due to myocardial hypertrophy or coronary microvascular dysfunction, in IHD is becoming increasingly recognized. Future studies should therefore be aimed at further improving our understanding of the integrated coronary microvascular mechanisms that control coronary blood flow, and of the underlying causes and mechanisms of coronary microvascular dysfunction. This knowledge will be essential to further improve the treatment of patients with IHD. PMID:25475073

  7. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial-adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is an infrequent and serious...... diagnostics and treatment strategy. Coronary intramural hematomas can also occur iatrogenically, as a complication to percutaneous coronary intervention (PCI). Coronary angiography (CAG) has limited diagnostic value in the absence of intimal dissections, and lesions are often angiographically ambiguous....... Intravascular ultrasound (IVUS) is an important diagnostic tool in establishing the correct diagnosis, as it provides a complete vessel wall assessment, and enables morphometric information regarding the magnitude and severity of the underlying hematoma. Due to the rarity of this clinical scenario...

  8. Endothelial dysfunction, carotid artery plaque burden, and conventional exercise-induced myocardial ischemia as predictors of coronary artery disease prognosis

    Directory of Open Access Journals (Sweden)

    Ishihara Masayuki

    2008-12-01

    Full Text Available Abstract Background While both flow-mediated vasodilation (FMD in the brachial artery (BA, which measures endothelium-dependent vasodilatation, and intima-media thickness (IMT in the carotid artery are correlated with the prognosis of coronary artery disease (CAD, it is not clear which modality is a better predictor of CAD. Furthermore, it has not been fully determined whether either of these modalities is superior to conventional ST-segment depression on exercise stress electrocardiogram (ECG as a predictor. Thus, the goal of the present study was to compare the predictive value of FMD, IMT, and stress ECG for CAD prognosis. Methods and Results A total of 103 consecutive patients (62 ± 9 years old, 79 men with clinically suspected CAD had FMD and nitroglycerin-induced dilation (NTG-D in the BA, carotid artery IMT measurement using high-resolution ultrasound, and exercise treadmill testing. The 73 CAD patients and 30 normal coronary patients were followed for 50 ± 15 months. Fifteen patients had coronary events during this period (1 cardiac death, 2 non-fatal myocardial infarctions, 3 acute heart failures, and 9 unstable anginas. On Kaplan-Meier analysis, only FMD and stress ECG were significant predictors for cardiac events. Conclusion Brachial endothelial function as reflected by FMD and conventional exercise stress testing has comparable prognostic value, whereas carotid artery plaque burden appears to be less powerful for predicting future cardiac events.

  9. Looking Forward, Looking Back: Future Challenges for Narrative Research An event commemorating the tenth anniversary of the Centre for Narrative Research, University of East London

    Directory of Open Access Journals (Sweden)

    Molly Andrews

    2011-01-01

    Full Text Available The Centre for Narrative Research was founded at the turn of the millenium. To commemorate its tenth anniversary, we organised an event which took place on November 10, 2010, at the Marx Memorial Library in London. The day had a very flexible format. We began with a few opening words from the three co-directors (Molly Andrews, Corinne Squire, and Maria Tamboukou and the Research Fellow (Cigdem Esin of CNR. This was followed by contributions from six leading narrative scholars (Jens Brockmeier, Michael Erben, Mark Freeman, Margareta Hydén, Margaretta Jolly, and Olivia Sagan to which Alexandra Georgakopoulou and Matti Hyvärinen then responded. Following lunch, the sixty participants were broken up into smaller groups, where they discussed issues raised in the morning session. The day concluded with a final discussion piece offered by Mike Rustin. The six presenters were faced with a formidable challenge. We invited them to write pieces of approximately 500 words on "the promise and challenges for future narrative research, including critiques of and hopes for our own scholarship." These were prepared in advance of the event, and sent to the discussants, who were asked not only to comment upon the set of issues raised, but also to provide a framework for looking at the problems as a whole set. Not only did the contributors and discussants come from a range of different backgrounds and geographical locations, but the range of intellectual interests represented by those who attended the day was very marked: poets, writers of fiction, policy makers, psychoanalysts, sociologists, psychologists, political scientists, social workers, and others. Perhaps the most outstanding feature of the day was the conversations which happened across boundaries, characterised by both a search for common ground as well as a recognition of the different intellectual standpoints represented by the people there. What follows are written versions of the prepared, spoken

  10. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Assante, Roberta; Zampella, Emilia; Nappi, Carmela; Mainolfi, Ciro Gabriele; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Acampa, Wanda [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Arumugam, Parthiban; Tonge, Christine M. [Central Manchester University Teaching Hospitals, Nuclear Medicine Center, Manchester (United Kingdom); Gaudieri, Valeria; Panico, Mariarosaria; Magliulo, Mario [Institute of Biostructure and Bioimaging, National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy)

    2017-12-15

    To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). We studied 436 patients undergoing hybrid {sup 82}Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0, <400, and ≥400). CFR was calculated as the ratio of hyperemic to baseline myocardial blood flow, and it was considered reduced when <2. Follow-up was 94% complete during a mean period of 47±15 months. During follow-up, 17 events occurred (4% cumulative event rate). Event-free survival decreased with worsening of CAC score category (p < 0.001) and in patients with reduced CFR (p < 0.005). At multivariable analysis, CAC score ≥400 (p < 0.01) and CFR (p < 0.005) were independent predictors of events. Including CFR in the prognostic model, continuous net reclassification improvement was 0.51 (0.14 in patients with events and 0.37 in those without). At classification and regression tree analysis, the initial split was on CAC score. For patients with a CAC score < 400, no further split was performed, while patients with a CAC score ≥400 were further stratified by CFR values. Decision curve analyses indicate that the model including CFR resulted in a higher net benefit across a wide range of decision threshold probabilities. In patients with suspected CAD, CFR provides significant incremental risk stratification over established cardiac risk factors and CAC score for prediction of adverse cardiac events. (orig.)

  11. [Endarterectomy of the coronary arteries].

    Science.gov (United States)

    Fischer, V; Simkovic, I; Holoman, M; Verchvodko, P; Janotík, P; Galbánek, J; Hulman, M; Kostelnicák, J; Jurco, R; Slezák, J

    1992-02-01

    The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

  12. Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress

    DEFF Research Database (Denmark)

    Nørgaard, Bjarne Linde; Leipsic, Jonathon; Koo, Bon-Kwon

    2016-01-01

    Fractional flow reserve (FFR) measured during invasive coronary angiography is an independent prognosticator in patients with coronary artery disease and the gold standard for decision making in coronary revascularization. The integration of computational fluid dynamics and quantitative anatomic...... and physiologic modeling now enables simulation of patient-specific hemodynamic parameters including blood velocity, pressure, pressure gradients, and FFR from standard acquired coronary computed tomography (CT) datasets. In this review article, we describe the potential impact on clinical practice...... and the science behind noninvasive coronary computed tomography (CT) angiography derived fractional flow reserve (FFRCT) as well as future applications of this technology in treatment planning and quantifying forces on atherosclerotic plaques....

  13. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  14. Selective coronary scintigraphy

    International Nuclear Information System (INIS)

    Gambini, D.-J.

    1975-01-01

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined [fr

  15. Congenital coronary artery fistula

    International Nuclear Information System (INIS)

    Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

    1986-01-01

    Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

  16. Clinical perspective of coronary computed tomographic angiography in diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Chang, Hyuk-Jae; Chung, Namsik

    2011-01-01

    Since a 4-detector row coronary computed tomographic angiography (CCTA) was launched in 1998, CCTA has experienced rapid improvement of imaging qualities with the ongoing evolution of computed tomography (CT) technology. The diagnostic accuracy of CCTA to detect coronary artery stenosis is well established, whereas improvements are still needed to reduce the overestimation of coronary artery disease (CAD) and assess plaque composition. CCTA has been used to evaluate CAD in various clinical settings. For example, CCTA could be an efficient initial triage tool at emergency departments for patients with acute chest pain with low-to-intermediate risk because of its high negative predictive value. In patients with suspected CAD, CCTA could be a cost-effective alternative to myocardial perfusion imaging and exercise electrocardiogram for the initial coronary evaluation of patients with intermediate pre-test likelihood suspected CAD. However, in asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Therefore, the clinical use of CCTA to detect CAD for purposes of risk stratification in asymptomatic individuals should be discouraged. As CT technology evolves, CCTA will provide better quality coronary imaging and non-coronary information with lower radiation exposure. Future studies should cover these ongoing technical improvements and evaluate the prognostic power of CCTA in various clinical settings of CAD in large, well-designed, randomized trials. (author)

  17. Plasma concentrations of ascorbic acid and C-reactive protein, and risk of future coronary artery disease, in apparently healthy men and women: the EPIC-Norfolk prospective population study

    NARCIS (Netherlands)

    Boekholdt, S. Matthijs; Meuwese, Marijn C.; Day, Nicholas E.; Luben, Robert; Welch, Ailsa; Wareham, Nicholas J.; Khaw, Kay-Tee

    2006-01-01

    High plasma concentrations of ascorbic acid, a marker of fruit and vegetable intake, are associated with low risk of coronary artery disease. Whether this relationship is explained by a reduction in systemic inflammation is unclear. We investigated the relationship between ascorbic acid plasma

  18. Coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

    2009-07-01

    Coronary CT angiography has attained increasing scientific attention at academic institutions and has become a highly accurate diagnostic modality. Extending this knowledge into a practice setting is the purpose of 'Coronary CT Angiography'. This book will assist you in integrating cardiac CT into your daily practice, while also giving an overview of the current technical status and applications. The specific features of scanners from all four main vendors are also presented providing an objective overview of noninvasive coronary angiography using CT. (orig.)

  19. Acute Coronary Syndrome

    Science.gov (United States)

    ... heart cells are dying. An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring ... Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  20. Coronary artery fistula

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2015:chap 84. Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: ... provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  1. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

  2. Acute coronary syndrome

    Science.gov (United States)

    ... Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol ... et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary ...

  3. Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics.

    Science.gov (United States)

    Lee, Joo Myung; Choi, Gilwoo; Koo, Bon-Kwon; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Kim, Kyung-Jin; Tong, Yaliang; Kim, Hyun Jin; Grady, Leo; Doh, Joon-Hyung; Nam, Chang-Wook; Shin, Eun-Seok; Cho, Young-Seok; Choi, Su-Yeon; Chun, Eun Ju; Choi, Jin-Ho; Nørgaard, Bjarne L; Christiansen, Evald H; Niemen, Koen; Otake, Hiromasa; Penicka, Martin; de Bruyne, Bernard; Kubo, Takashi; Akasaka, Takashi; Narula, Jagat; Douglas, Pamela S; Taylor, Charles A; Kim, Hyo-Soo

    2018-03-14

    We investigated the utility of noninvasive hemodynamic assessment in the identification of high-risk plaques that caused subsequent acute coronary syndrome (ACS). ACS is a critical event that impacts the prognosis of patients with coronary artery disease. However, the role of hemodynamic factors in the development of ACS is not well-known. Seventy-two patients with clearly documented ACS and available coronary computed tomographic angiography (CTA) acquired between 1 month and 2 years before the development of ACS were included. In 66 culprit and 150 nonculprit lesions as a case-control design, the presence of adverse plaque characteristics (APC) was assessed and hemodynamic parameters (fractional flow reserve derived by coronary computed tomographic angiography [FFR CT ], change in FFR CT across the lesion [△FFR CT ], wall shear stress [WSS], and axial plaque stress) were analyzed using computational fluid dynamics. The best cut-off values for FFR CT , △FFR CT , WSS, and axial plaque stress were used to define the presence of adverse hemodynamic characteristics (AHC). The incremental discriminant and reclassification abilities for ACS prediction were compared among 3 models (model 1: percent diameter stenosis [%DS] and lesion length, model 2: model 1 + APC, and model 3: model 2 + AHC). The culprit lesions showed higher %DS (55.5 ± 15.4% vs. 43.1 ± 15.0%; p stress than nonculprit lesions (all p values statistic [c-index] 0.789 vs. 0.747; p = 0.014) and reclassification abilities (category-free net reclassification index 0.287; p = 0.047; relative integrated discrimination improvement 0.368; p < 0.001) than model 2. Lesions with both APC and AHC showed significantly higher risk of the culprit for subsequent ACS than those with no APC/AHC (hazard ratio: 11.75; 95% confidence interval: 2.85 to 48.51; p = 0.001) and with either APC or AHC (hazard ratio: 3.22; 95% confidence interval: 1.86 to 5.55; p < 0.001). Noninvasive hemodynamic assessment enhanced

  4. Trans-oceanic transport of {sup 137}Cs from the Fukushima nuclear accident and impact of hypothetical Fukushima-like events of future nuclear plants in Southern China

    Energy Technology Data Exchange (ETDEWEB)

    Wai, Ka-Ming, E-mail: bhkmwai@cityu.edu.hk [Department of Geological and Mining Engineering and Sciences, Michigan Technological University, Houghton, MI (United States); Department of Physics and Material Science, City University of Hong Kong, Hong Kong (China); Yu, Peter K.N. [Department of Physics and Material Science, City University of Hong Kong, Hong Kong (China)

    2015-03-01

    A Lagrangian model was adopted to assess the potential impact of {sup 137}Cs released from hypothetical Fukushima-like accidents occurring on three potential nuclear power plant sites in Southern China in the near future (planned within 10 years) in four different seasons. The maximum surface (0–500 m) {sup 137}Cs air concentrations would be reached 10 Bq m{sup −3} near the source, comparable to the Fukushima case. In January, Southeast Asian countries would be mostly affected by the radioactive plume due to the effects of winter monsoon. In April, the impact would be mainly on Southern and Northern China. Debris of radioactive plume (∼ 1 mBq m{sup −3}) would carry out long-range transport to North America. The area of influence would be the smallest in July due to the frequent and intense wet removal events by trough of low pressure and tropical cyclone. The maximum worst-case areas of influence were 2382000, 2327000, 517000 and 1395000 km{sup 2} in January, April, July and October, respectively. Prior to the above calculations, the model was employed to simulate the trans-oceanic transport of {sup 137}Cs from the Fukushima nuclear accident. Observed and modeled {sup 137}Cs concentrations were comparable. Sensitivity runs were performed to optimize the wet scavenging parameterization. The adoption of higher-resolution (1° × 1°) meteorological fields improved the prediction. The computed large-scale plume transport pattern over the Pacific Ocean was compared with that reported in the literature. - Highlights: • A Lagrangian model was used to predict the dispersion of {sup 137}Cs from plant accident. • Observed and modeled {sup 137}Cs concentrations were comparable for the Fukushima accident. • The maximum surface concentrations could reach 10 Bq m{sup −3} for the hypothetical case. • The hypothetical radiative plumes could impact E/SE Asia and N. America.

  5. Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

    Directory of Open Access Journals (Sweden)

    Marat Fudim

    2016-03-01

    Full Text Available The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD, to assess an individual׳s risk of future cardiovascular disease (CVD events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA is a population based study (n=6814 of White (38%, Black (28%, Chinese (22% and Hispanic (12% subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS performance across gender and ethnicities. Keywords: Risk stratification, Coronary calcium scoring, Gender, Ethnicity, MESA, {C}{C}

  6. A Review of Coronary Artery Disease Research in Malaysia.

    Science.gov (United States)

    Ang, C S; Chan, K M J

    2016-06-01

    Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

  7. Coronary hemodynamics in vasospastic angina

    International Nuclear Information System (INIS)

    Matsumura, Kentaro; Kubota, Shinobu; Serizawa, Takashi; Nakase, Emiko; Kawai, Ichiro; Saito, Takayuki

    1991-01-01

    To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77±0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65±0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca ++ -antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T 1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion. (author)

  8. Coronary tortuosity: a long and winding road.

    NARCIS (Netherlands)

    Zegers, E.S.; Meursing, B.T.J.; Oude Ophuis, A.J.M.

    2007-01-01

    Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise

  9. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  10. Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups

    International Nuclear Information System (INIS)

    Hwang, Y.; Kim, Y.; Chung, I.-M.; Ryu, J.; Park, H.

    2010-01-01

    Aim: To evaluate the prevalence of coronary artery disease (CAD) in relation to risk of coronary heart disease (CHD) and assess plaque characteristics from coronary computed tomography (CT) angiography in asymptomatic and symptomatic patients. Materials and methods: Three hundred and ninety consecutive patients [asymptomatic group, n = 138; symptomatic group (atypical or non-anginal chest pain), n = 252] were retrospectively enrolled. They were subsequently classified into three CHD risk categories, based on the National Cholesterol Education Program guidelines, and 10 year risks of coronary events were calculated using Framingham risk score. CT was evaluated for stenosis, plaque composition, and coronary calcium scores. Results: CAD was observed in 42% of the asymptomatic group and 62% of the symptomatic group. In the former, the prevalence of CAD in low-, moderate- and high-risk subgroups was 21.4, 47.4 and 65%, respectively, and was 33.3, 74.4, and 72.4% in the symptomatic group. Framingham 10-year risks of coronary events were significantly higher in patients with CAD than in normal participants, and receiver operating characteristics curves showed that discriminatory power was poor in the asymptomatic group and symptomatic men, and good in symptomatic women. Of the participants in the asymptomatic group, 12% exhibited only non-calcified plaques and of the symptomatic group, 7% exhibited only non-calcified plaques. The coronary calcium score was significantly higher for significant stenosis than for non-significant stenosis in both groups. Conclusions: The prevalence of CAD was not negligible even in subgroups with low-to-moderate CHD risk. Additionally, the Framingham risk score was effective for predicting CAD only in symptomatic women. Coronary calcium scores correlated with significant stenosis; however, a sizeable percentage of both groups had only non-calcified plaques.

  11. Systematic preoperative coronary angiography and stenting improves postoperative results of carotid endarterectomy in patients with asymptomatic coronary artery disease: a randomised controlled trial.

    Science.gov (United States)

    Illuminati, G; Ricco, J-B; Greco, C; Mangieri, E; Calio', F; Ceccanei, G; Pacilè, M A; Schiariti, M; Tanzilli, G; Barillà, F; Paravati, V; Mazzesi, G; Miraldi, F; Tritapepe, L

    2010-02-01

    To evaluate the usefulness of systematic coronary angiography followed, if needed, by coronary artery angioplasty (percutaneous coronary intervention (PCI)) on the incidence of cardiac ischaemic events after carotid endarterectomy (CEA) in patients without evidence of coronary artery disease (CAD). From January 2005 to December 2008, 426 patients, candidates for CEA, with no history of CAD and with normal cardiac ultrasound and electrocardiography (ECG), were randomised into two groups. In group A (n=216) all the patients had coronary angiography performed before CEA. In group B, all the patients had CEA without previous coronary angiography. In group A, 66 patients presenting significant coronary artery lesions at angiography received PCI before CEA. They subsequently underwent surgery under aspirin (100 mg day(-1)) and clopidogrel (75 mg day(-1)). CEA was performed within a median delay of 4 days after PCI (range: 1-8 days). Risk factors, indications for CEA and surgical techniques were comparable in both groups (p>0.05). The primary combined endpoint of the study was the incidence of postoperative myocardial ischaemic events combined with the incidence of complications of coronary angiography. Secondary endpoints were death and stroke rates after CEA and incidence of cervical haematoma. Postoperative mortality was 0% in group A and 0.9% in group B (p=0.24). One postoperative stroke (0.5%) occurred in group A, and two (0.9%) in group B (p=0.62). No postoperative myocardial event was observed in group A, whereas nine ischaemic events were observed in group B, including one fatal myocardial infarction (p=0.01). Binary logistic regression analysis demonstrated that preoperative coronary angiography was the only independent variable that predicted the occurrence of postoperative coronary ischaemia after CEA. The odds ratio for coronary angiography (group A) indicated that when holding all other variables constant, a patient having preoperative coronary angiography

  12. Prognostic value of Tc-99m tetrofosmin myocardial perfusion gated SPECT in patients with diabetes mellitus and suspected coronary artery disease

    International Nuclear Information System (INIS)

    Santos, Marcia Maria Sales dos; Pantoja, Mauricio da Rocha; Cwajg, Eduardo

    2008-01-01

    Background: The cardiovascular disease is the main cause of death among diabetic patients, which makes it crucial to identify the individuals at higher risk of cardiovascular events. Objective: To evaluate the prognostic value of scintigraphy with gated single photon emission computed tomography (SPECT) in patients with diabetes mellitus (DM) and suspected coronary artery disease. Methods: Retrospective study with 232 diabetic patients submitted to scintigraphy with gated SPECT. Perfusion Gated SPECT (scores and number of altered segments) as well as ventricular function parameters (ejection fraction, left ventricle volume and contractility) were evaluated. Cardiac death, acute ischemic coronary syndrome, revascularization procedures or encephalic vascular accident were considered future cardiovascular events. The uni- and multivariate analyses were carried out by the multiple logistic regression model (p< 0.05). Results: At the univariate analysis, age (p=0.02), chest angina (p=0.01), insulin therapy (p=0.02), myocardial perfusion abnormalities (p<0.0001), the number of segments involved (p=0.0001), the perfusion scores (p=0.0001), the ejection fraction (p=0.004), the final systolic volume (p=0.03) and the finding of segmental alteration at the LV contractility (p<0.0001) were associated with future events at the univariate analysis. At the multivariate analysis, the male sex (p=0.007), age (p=0.03), angina (p=0.001), insulin therapy (p=0.007) and the SDS ≥ 3 (p=0.0001), and the number of altered segments ≥ 3 (p=0.0001) were predictors of cardiovascular events. Conclusion: The myocardial scintigraphy with gated SPECT adds independent information to the stratification of the risk of future cardiovascular events in patients with DM and suspected coronary artery disease. (author)

  13. Prognostic value of Tc-99m tetrofosmin myocardial perfusion gated SPECT in patients with diabetes mellitus and suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcia Maria Sales dos; Pantoja, Mauricio da Rocha; Cwajg, Eduardo [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); CINTILAB, Rio de Janeiro, RJ (Brazil); E-mail: mmsales@oi.com.br

    2008-01-15

    Background: The cardiovascular disease is the main cause of death among diabetic patients, which makes it crucial to identify the individuals at higher risk of cardiovascular events. Objective: To evaluate the prognostic value of scintigraphy with gated single photon emission computed tomography (SPECT) in patients with diabetes mellitus (DM) and suspected coronary artery disease. Methods: Retrospective study with 232 diabetic patients submitted to scintigraphy with gated SPECT. Perfusion Gated SPECT (scores and number of altered segments) as well as ventricular function parameters (ejection fraction, left ventricle volume and contractility) were evaluated. Cardiac death, acute ischemic coronary syndrome, revascularization procedures or encephalic vascular accident were considered future cardiovascular events. The uni- and multivariate analyses were carried out by the multiple logistic regression model (p< 0.05). Results: At the univariate analysis, age (p=0.02), chest angina (p=0.01), insulin therapy (p=0.02), myocardial perfusion abnormalities (p<0.0001), the number of segments involved (p=0.0001), the perfusion scores (p=0.0001), the ejection fraction (p=0.004), the final systolic volume (p=0.03) and the finding of segmental alteration at the LV contractility (p<0.0001) were associated with future events at the univariate analysis. At the multivariate analysis, the male sex (p=0.007), age (p=0.03), angina (p=0.001), insulin therapy (p=0.007) and the SDS {>=} 3 (p=0.0001), and the number of altered segments {>=} 3 (p=0.0001) were predictors of cardiovascular events. Conclusion: The myocardial scintigraphy with gated SPECT adds independent information to the stratification of the risk of future cardiovascular events in patients with DM and suspected coronary artery disease. (author)

  14. Acute coronary ischemia during alcohol withdrawal: a case report

    Directory of Open Access Journals (Sweden)

    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  15. Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

    International Nuclear Information System (INIS)

    Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

    2010-01-01

    To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

  16. 1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Eitel, Ingo; Galasso, Gennaro

    2016-01-01

    BACKGROUND: Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.......68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis...

  17. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  18. Thoracic fat volume is independently associated with coronary vasomotion

    Energy Technology Data Exchange (ETDEWEB)

    Dunet, Vincent; Allenbach, Gilles; Prior, John O. [Lausanne University Hospital, Department of Nuclear Medicine and Molecular Imaging, Lausanne (Switzerland); Feihl, Francois; Dabiri, Amin; Waeber, Bernard [Lausanne University Hospital, Department of Clinical Physiopathology, Lausanne (Switzerland); Heinzer, Raphael [Lausanne University Hospital, Center for Investigation and Research in Sleep, Lausanne (Switzerland)

    2016-02-15

    Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a {sup 82}Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events. (orig.)

  19. Thoracic fat volume is independently associated with coronary vasomotion

    International Nuclear Information System (INIS)

    Dunet, Vincent; Allenbach, Gilles; Prior, John O.; Feihl, Francois; Dabiri, Amin; Waeber, Bernard; Heinzer, Raphael

    2016-01-01

    Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a 82 Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events. (orig.)

  20. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Staziaki, Pedro V.; Vadvala, Harshna; Kim, Phillip; Meyersohn, Nandini M.; Janjua, Sumbal A.; Hoffmann, Udo [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Neilan, Tomas G.; Francis, Sanjeev [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Bittner, Daniel [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Medicine 2 - Cardiology, Erlangen (Germany); Mayrhofer, Thomas [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Stralsund University of Applied Sciences, School of Business Studies, Stralsund (Germany); Greenwald, Jeffrey L. [Massachusetts General Hospital and Harvard Medical School, Department of Medicine, Boston, MA (United States); Truong, Quyhn A. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Weill Cornell College of Medicine, Department of Radiology, New York, NY (United States); Abbara, Suhny [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); UT Southwestern Medical Center, Department Cardiothoracic Imaging, Dallas, TX (United States); Brown, David F.M.; Nagurney, John T. [Massachusetts General Hospital and Harvard Medical School, Department of Emergency Medicine, Boston, MA (United States); Januzzi, James L. [Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Collaboration: MGH Emergency Cardiac CTA Program Contributors

    2017-07-15

    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. (orig.)

  1. Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population.

    Science.gov (United States)

    Willemink, Martin J; Takx, Richard A P; Išgum, Ivana; de Koning, Harry J; Oudkerk, Matthijs; Mali, Willem P Th M; Budde, Ricardo P J; Leiner, Tim; Vliegenthart, Rozemarijn; de Jong, Pim A

    2015-08-01

    To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95% confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0%) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0% (n = 59) or 12.9% (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95% CI, 1.09-1.84) and 2.74 (95% CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95% CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events.

  2. Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Margarete Ártico Batista

    2006-09-01

    Full Text Available OBJETIVO: Descrever os eventos adversos ocorridos durante e após angioplastia coronária (ATC, possivelmente relacionados ao reuso de produtos médico-hospitalares, além de quantificar e identificar os motivos de descarte em relação ao primeiro uso e ao reuso. MÉTODO: Foram estudados 60 pacientes, sendo que 29 (48,3% apresentavam angina instável, 27 (45% IAM e quatro (6,7% outros diagnósticos. Durante o procedimento e na permanência na Unidade Intensiva Coronariana, atentou-se à possibilidade de ocorrência dos eventos adversos febre, hipertensão, hipotensão, calafrios, sudorese, sangramento, náuseas e vômitos. Foram avaliados sete produtos médico-hospitalares: introdutor, cateter-guia, fio-guia 0.35, fio-guia 0.014, cateter- balão para angioplastia, seringa com manômetro para insuflar balão (indeflator e torneira de três vias (manifold. No total de produtos (76 de primeiro uso e 410 reprocessados, verificou-se se houve descarte e se isto ocorreu antes ou durante o procedimento e quais os motivos para tanto. Utilizou-se o teste Qui Quadrado, admitindo-se erro alfa de 5%. RESULTADOS: Vinte e seis pacientes apresentaram eventos adversos. A hipotensão foi o evento mais prevalente e ocorreu em 11(18,3% casos. Não houve, porém, significância estatística entre o evento adverso hipotensão e reuso ou não dos produtos médico-hospitalares. Por não estarem íntegros, foram descartados três produtos de primeiro uso e 55 produtos dos reutilizados. CONCLUSÃO: Os eventos adversos apresentados pelos pacientes submetidos à angioplastia não estão associados ao reuso dos produtos médico-hospitalares. A integridade e funcionalidade foram os motivos principais de descarte.OBJECTIVE: To describe the adverse effects that occur during and after percutaneous transluminal coronary angioplasty (PTCA possibly related to the reuse of medical equipment. An additional objective is to quantify and identify the reasons of discard in respect to

  3. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with drug-eluting stents for patients with multivessel coronary artery disease.

    Science.gov (United States)

    Javaid, Aamir; Steinberg, Daniel H; Buch, Ashesh N; Corso, Paul J; Boyce, Steven W; Pinto Slottow, Tina L; Roy, Probal K; Hill, Peter; Okabe, Teruo; Torguson, Rebecca; Smith, Kimberly A; Xue, Zhenyi; Gevorkian, Natalie; Suddath, William O; Kent, Kenneth M; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2007-09-11

    Advances in coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) with drug-eluting stents have dramatically improved results of these procedures. The optimal treatment for patients with multivessel coronary artery disease is uncertain given the lack of prospective, randomized data reflecting current practice. This study represents a "real-world" evaluation of current technology in the treatment of multivessel coronary artery disease. A total of 1680 patients undergoing revascularization for multivessel coronary artery disease were identified. Of these, 1080 patients were treated for 2-vessel disease (196 CABG and 884 PCI) and 600 for 3-vessel disease (505 CABG and 95 PCI). One-year mortality, cerebrovascular events, Q-wave myocardial infarction, target vessel failure, and composite major adverse cardiovascular and cerebrovascular events were compared between the CABG and PCI cohorts. Outcomes were adjusted for baseline covariates and reported as hazard ratios. The unadjusted major adverse cardiovascular and cerebrovascular event rate was reduced with CABG for patients with 2-vessel disease (9.7% CABG versus 21.2% PCI; P<0.001) and 3-vessel disease (10.8% CABG versus 28.4% PCI; P<0.001). Adjusted outcomes showed increased major adverse cardiovascular and cerebrovascular event with PCI for patients with 2-vessel (hazard ratio 2.29; 95% CI 1.39 to 3.76; P=0.01) and 3-vessel disease (hazard ratio 2.90; 95% CI 1.76 to 4.78; P<0.001). Adjusted outcomes for the nondiabetic subpopulation demonstrated equivalent major adverse cardiovascular and cerebrovascular event with PCI for 2-vessel (hazard ratio 1.77; 95% CI 0.96 to 3.25; P=0.07) and 3-vessel disease (hazard ratio 1.70; 95% CI 0.77 to 3.61; P=0.19). Compared with PCI with drug-eluting stents, CABG resulted in improved major adverse cardiovascular and cerebrovascular event in patients with 2- and 3-vessel coronary artery disease, primarily in those with underlying diabetes

  4. Gender differences in coronary plaque composition by coronary computed tomography angiography.

    Science.gov (United States)

    Blaha, Michael J; Nasir, Khurram; Rivera, Juan J; Choi, Eue-Keun; Chang, Sung-A; Yoon, Yeonyee E; Chun, Eun Ju; Choi, Sang-il; Agatston, Arthur; Blumenthal, Roger S; Chang, Hyuk-Jae

    2009-12-01

    Coronary computed tomography angiography allows the differentiation of non-calcified (NCAP), calcified (CAP), and mixed coronary artery plaques (MCAP). Although males are thought to have a higher prevalence of atherosclerosis for a given age, there are currently few data regarding age-adjusted sex differences in plaque morphology and composition. We studied 1015 consecutive asymptomatic South Korean patients (49+/-10 years, 64% men) who underwent 64-slice coronary computed tomography angiography during a routine health evaluation. Coronary plaque characteristics were analyzed on a per-segment basis according to the modified AHA classification. Plaques with more than 50% calcified tissue were classified as CAP, plaques with less than 50% calcified tissue were classified as MCAP, and plaques without calcium were classified as NCAP. Multiple regression analysis was used to describe the cross-sectional association between sex and plaque-type burden (>or=2 affected segments) after adjustment for age and other cardiovascular risk factors. There was a greater prevalence of coronary plaque among men (13 vs. 4%, PNCAP was similar across sex (2 vs. 1%, P = 0.28). After multivariable adjustment, men have six to seven times greater odds of having an increased burden of CAP and MCAP, whereas no sex difference was observed in the burden of NCAP. In this population of asymptomatic middle-aged Korean individuals, males had a significantly greater burden of MCAP and CAP. Future studies will determine whether these differences contribute to the accelerated cardiovascular risk observed in men.

  5. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  6. Prognostic value of computed tomography coronary angiography in patients with suspected coronary artery disease: a 24-month follow-up study

    Energy Technology Data Exchange (ETDEWEB)

    Aldrovandi, Annachiara; Maffei, Erica; Seitun, Sara; Martini, Chiara; Ruffini, Livia; Crisi, Girolamo; Ardissino, Diego [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Palumbo, Alessandro [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Brambilla, Valerio [University of Parma, Cardiovascular Prevention and Rehabilitation Unit, Don Gnocchi ONLUS, Parma (Italy); Zuccarelli, Alessandra [Ospedale di Carrara, Department of Cardiology, Carrara (Italy); Tarantini, Giuseppe [University of Padua, Department of Cardiology, Padua (Italy); Weustink, Annick C.; Mollet, Nico R.; Feyter, Pim J. de; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Cademartiri, Filippo [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria di Parma, Department of Radiology, c/o Piastra Tecnica - Piano 0 - CT Section, Parma (Italy)

    2009-07-15

    The aim of this study was to determine the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major cardiac events in patients with suspected coronary artery disease (CAD). A total of 187 consecutive patients (119 men, age 62.5 {+-} 10.5 years) without known heart disease underwent single-source 64-slice CTCA (Somatom Sensation 64, Siemens) for clinical suspicion of CAD. Patients underwent follow-up for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina and cardiac revascularization. In total, 2,822 coronary segments were assessed. Forty-two segments (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed absence of CAD in 65 (34.7%) patients, nonobstructive CAD (coronary plaque {<=}50%) in 87 (46.5%) patients and obstructive CAD (>50%) in 35 (18.8%) patients. A total of 20 major cardiac events (3 myocardial infarctions, 16 cardiac revascularizations, 1 unstable angina) occurred during a mean follow-up of 24 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD and three events occurred in the group of nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. CTCA has a 100% negative predictive value for major cardiac events at 24-month follow-up in patients with normal coronary arteries. (orig.)

  7. Prognostic value of computed tomography coronary angiography in patients with suspected coronary artery disease: a 24-month follow-up study

    International Nuclear Information System (INIS)

    Aldrovandi, Annachiara; Maffei, Erica; Seitun, Sara; Martini, Chiara; Ruffini, Livia; Crisi, Girolamo; Ardissino, Diego; Palumbo, Alessandro; Brambilla, Valerio; Zuccarelli, Alessandra; Tarantini, Giuseppe; Weustink, Annick C.; Mollet, Nico R.; Feyter, Pim J. de; Krestin, Gabriel P.; Cademartiri, Filippo

    2009-01-01

    The aim of this study was to determine the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major cardiac events in patients with suspected coronary artery disease (CAD). A total of 187 consecutive patients (119 men, age 62.5 ± 10.5 years) without known heart disease underwent single-source 64-slice CTCA (Somatom Sensation 64, Siemens) for clinical suspicion of CAD. Patients underwent follow-up for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina and cardiac revascularization. In total, 2,822 coronary segments were assessed. Forty-two segments (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed absence of CAD in 65 (34.7%) patients, nonobstructive CAD (coronary plaque ≤50%) in 87 (46.5%) patients and obstructive CAD (>50%) in 35 (18.8%) patients. A total of 20 major cardiac events (3 myocardial infarctions, 16 cardiac revascularizations, 1 unstable angina) occurred during a mean follow-up of 24 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD and three events occurred in the group of nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. CTCA has a 100% negative predictive value for major cardiac events at 24-month follow-up in patients with normal coronary arteries. (orig.)

  8. The human coronary vasodilatory response to acute mental stress is mediated by neuronal nitric oxide synthase.

    Science.gov (United States)

    Khan, Sitara G; Melikian, Narbeh; Shabeeh, Husain; Cabaco, Ana R; Martin, Katherine; Khan, Faisal; O'Gallagher, Kevin; Chowienczyk, Philip J; Shah, Ajay M

    2017-09-01

    Mental stress-induced ischemia approximately doubles the risk of cardiac events in patients with coronary artery disease, yet the mechanisms underlying changes in coronary blood flow in response to mental stress are poorly characterized. Neuronal nitric oxide synthase (nNOS) regulates basal coronary blood flow in healthy humans and mediates mental stress-induced vasodilation in the forearm. However, its possible role in mental stress-induced increases in coronary blood flow is unknown. We studied 11 patients (6 men and 5 women, mean age: 58 ± 14 yr) undergoing elective diagnostic cardiac catheterization and assessed the vasodilator response to mental stress elicited by the Stroop color-word test. Intracoronary substance P (20 pmol/min) and isosorbide dinitrate (1 mg) were used to assess endothelium-dependent and -independent vasodilation, respectively. Coronary blood flow was estimated using intracoronary Doppler recordings and quantitative coronary angiography to measure coronary artery diameter. Mental stress increased coronary flow by 34 ± 7.0% over the preceding baseline during saline infusion ( P stress increased coronary artery diameter by 6.9 ± 3.7% ( P = 0.02) and 0.5 ± 2.8% ( P = 0.51) in the presence of S -methyl-l-thiocitrulline. The response to substance P did not predict the response to mental stress ( r 2 = -0.22, P = 0.83). nNOS mediates the human coronary vasodilator response to mental stress, predominantly through actions at the level of coronary resistance vessels. NEW & NOTEWORTHY Acute mental stress induces vasodilation of the coronary microvasculature. Here, we show that this response involves neuronal nitric oxide synthase in the human coronary circulation.Listen to this article's corresponding podcast at http://ajpheart.podbean.com/e/nnos-and-coronary-flow-during-mental-stress/. Copyright © 2017 the American Physiological Society.

  9. The human coronary vasodilatory response to acute mental stress is mediated by neuronal nitric oxide synthase

    Science.gov (United States)

    Khan, Sitara G.; Melikian, Narbeh; Shabeeh, Husain; Cabaco, Ana R.; Martin, Katherine; Khan, Faisal; O’Gallagher, Kevin; Chowienczyk, Philip J.

    2017-01-01

    Mental stress-induced ischemia approximately doubles the risk of cardiac events in patients with coronary artery disease, yet the mechanisms underlying changes in coronary blood flow in response to mental stress are poorly characterized. Neuronal nitric oxide synthase (nNOS) regulates basal coronary blood flow in healthy humans and mediates mental stress-induced vasodilation in the forearm. However, its possible role in mental stress-induced increases in coronary blood flow is unknown. We studied 11 patients (6 men and 5 women, mean age: 58 ± 14 yr) undergoing elective diagnostic cardiac catheterization and assessed the vasodilator response to mental stress elicited by the Stroop color-word test. Intracoronary substance P (20 pmol/min) and isosorbide dinitrate (1 mg) were used to assess endothelium-dependent and -independent vasodilation, respectively. Coronary blood flow was estimated using intracoronary Doppler recordings and quantitative coronary angiography to measure coronary artery diameter. Mental stress increased coronary flow by 34 ± 7.0% over the preceding baseline during saline infusion (P coronary artery diameter by 6.9 ± 3.7% (P = 0.02) and 0.5 ± 2.8% (P = 0.51) in the presence of S-methyl-l-thiocitrulline. The response to substance P did not predict the response to mental stress (r2 = −0.22, P = 0.83). nNOS mediates the human coronary vasodilator response to mental stress, predominantly through actions at the level of coronary resistance vessels. NEW & NOTEWORTHY Acute mental stress induces vasodilation of the coronary microvasculature. Here, we show that this response involves neuronal nitric oxide synthase in the human coronary circulation. Listen to this article’s corresponding podcast at http://ajpheart.podbean.com/e/nnos-and-coronary-flow-during-mental-stress/. PMID:28646032

  10. Platelet hyperreactivity in response to on- and off-pump coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Bochsen, Louise; Rosengaard, Lisbeth Bredahl; Nielsen, Allan Bybeck

    2009-01-01

    Hypercoagulability has been reported after off-pump coronary artery bypass grafting (OPCAB) compared with patients undergoing standard coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The aim of this study was to evaluate the changes in platelet reactivity in response to cardiac...... and this study identified 23% of patients needing coronary bypass surgery to be at high risk for recurrent ischemic events at 1 month after surgery, based on the MA. These results suggest that a more aggressive antithrombotic treatment might be warranted for patients undergoing coronary artery bypass grafting...

  11. CT myocardial perfusion imaging: current status and future perspectives.

    Science.gov (United States)

    Yang, Dong Hyun; Kim, Young-Hak

    2017-07-01

    Computed tomography myocardial perfusion (CTP) combined with coronary computed tomography angiography (CCTA) may constitute a "1-stop shop" for the noninvasive diagnosis of hemodynamically significant coronary stenosis during a single CT examination. CTP shows high diagnostic performance and provides incremental value over CCTA for the detection of hemodynamically significant coronary stenosis in patients with a high Agatston calcium score or coronary artery stents. Future studies should determine the optimal protocol and clinical value of CTP for guiding revascularization strategy and prognostication. In this article, we review the current status and future perspectives of CTP, focusing on technical considerations, clinical applications, and future research topics.

  12. Impact of cigarette smoking on the relationship between body mass index and coronary heart disease: a pooled analysis of 3264 stroke and 2706 CHD events in 378579 individuals in the Asia Pacific region

    Directory of Open Access Journals (Sweden)

    2009-08-01

    Full Text Available Abstract Background Elevated levels of body mass index (BMI and smoking are well established lifestyle risk factors for coronary heart disease (CHD and stroke. If these two risk factors have a synergistic relationship, rigorous lifestyle modification may contribute to greater reduction in cardiovascular burden than previously expected. Methods A pooled analysis of individual participant data from 38 cohorts, involving 378,579 participants. Hazards ratios (HRs and 95% confidence intervals (CIs for BMI by cigarette smoking status were estimated using Cox proportional hazard models. Results During a mean follow-up of 3.8 years, 2706 CHD and 3264 strokes were recorded. There was a log-linear, positive relationship of BMI with CHD and stroke in both smokers and non-smokers with evidence of a synergistic effect of smoking on the association between BMI and CHD only: HRs (95% CIs associated with a 2 kg/m2 higher BMI were 1.13 (1.10 – 1.17 in current smokers and 1.09 (1.06 – 1.11 in non-smokers (p-value for interaction = 0.04. Conclusion Smoking amplifies the positive association between BMI and CHD but not stroke. If confirmed, these results suggest that effective strategies that target smoking cessation and weight loss are likely to have a greater impact than anticipated on reducing the burden of CHD.

  13. Nuclear cardiology. I - Radionuclide angiographic assessment of left ventricular contraction: uses, limitations and future directions. II - The role of myocardial perfusion imaging using thallium-201 in diagnosis of coronary heart disease

    International Nuclear Information System (INIS)

    Bodenheimer, M.M.; Banka, V.S.; Helfant, R.H.; Pennsylvania, University, Philadelphia, PA)

    1980-01-01

    The current status of radionuclide angiography is reviewed. First pass and gated equilibrium methods for determining left ventricular contraction are compared. Some clinical applications of radionuclide angiography are then examined, including the detection of discrete versus diffuse asynergy and the assessment of myocardial infarction. The second part of this work reviews the uses and limitations of thallium-201 perfusion imaging in the diagnosis of the acute and chronic manifestations of coronary heart disease. Theoretical and technical considerations of thallium-201 imaging are reviewed along with the clinical implications of the technique

  14. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  15. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

  16. Percutaneous coronary intervention in asians- are there differences in clinical outcome?

    Directory of Open Access Journals (Sweden)

    Chua Terrance S

    2011-05-01

    Full Text Available Abstract Background Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD. Methods A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE of myocardial infarction (MI, repeat revascularization and all-cause death at six months. Results 7889 patients underwent PCI; 7544 (96% patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11. There were 5130 (68% Chinese, 1056 (14% Malays and 1001 (13.3% Indian patients. The remaining 357 (4.7% patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1% patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p Conclusion These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.

  17. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

    Directory of Open Access Journals (Sweden)

    Dinesha Basavanna

    2017-01-01

    Full Text Available Aim: Spontaneous coronary artery dissection (SCAD is a rare cause of angina, myocardial infarction (MI, and sudden cardiac death (SCD and may frequently manifest as acute coronary syndrome (ACS. The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.

  18. Coronary artery anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  19. Coronary MR angiography: current status

    International Nuclear Information System (INIS)

    Danias, P.G.; Manning, W.J.

    2000-01-01

    Since first described in the early 1990s, coronary magnetic resonance angiography (MRA) has evolved as a promising noninvasive modality for imaging of the coronary arteries and evaluation of coronary artery disease. Despite technical limitations, coronary MRA has established value for imaging of anomalous coronary arteries and assessment of bypass graft patency. Current research focuses on the development of optimal respiratory compensation strategies, improved spatial and temporal resolution and faster acquisition of image data. The accurate detection of stenoses and assessment of the severity of coronary atherosclerosis is presently being evaluated with large multi-center studies. With further technique enhancements and more clinical experience, coronary MRA is likely to become the dominant noninvasive modality in clinical cardiology. (orig.) [de

  20. Invasive or non-invasive imaging for detecting high-risk coronary lesions?

    NARCIS (Netherlands)

    K. Patel (Kush); J. Tarkin (Jason); P.W.J.C. Serruys (Patrick); E. Tenekecioglu (Erhan); N. Foin (Nicolas); Y. Zhang (Yaojun); T. Crake (Tom); J. Moon (James); A. Mathur (Anthony); C.V. Bourantas (Christos)

    2017-01-01

    markdownabstract_Introduction:_ Advances in our understanding about atherosclerotic evolution have enabled us to identify specific plaque characteristics that are associated with coronary plaque vulnerability and cardiovascular events. With constant improvements in signal and image processing an

  1. Effects of dalcetrapib in patients with a recent acute coronary syndrome

    DEFF Research Database (Denmark)

    Schwartz, Gregory G; Olsson, Anders G; Abt, Markus

    2012-01-01

    In observational analyses, higher levels of high-density lipoprotein (HDL) cholesterol have been associated with a lower risk of coronary heart disease events. However, whether raising HDL cholesterol levels therapeutically reduces cardiovascular risk remains uncertain. Inhibition of cholesteryl...

  2. Coronary artery disease is associated with an increased mortality rate following video-assisted thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Sandri, Alberto; Petersen, Rene Horsleben; Decaluwé, Herbert

    2017-01-01

    OBJECTIVE: To compare the incidence of major adverse cardiac events (MACE) and mortality following video-assisted thoracoscopic surgery (VATS) lobectomy in patients with and without coronary artery disease (CAD). METHODS: Multicentre retrospective analysis of 1699 patients undergoing VATS lobectomy...

  3. Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

    Science.gov (United States)

    Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

    2013-10-10

    Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

  4. [Coronary heart disease: epidemiologic-genetic aspects].

    Science.gov (United States)

    Epstein, F H

    1985-01-01

    Coronary heart disease and the risk factors which predispose to it aggregate in families. How much of this clustering of disease is "explained" by the familial resemblance in predisposing factors? The published reports which bear on this question fall into six distinct study designs: prospective studies, persons at high or low risk or persons with and without a positive family history as points of departure, case-control studies, studies of patients who had a coronary angiogram and studies in different ethnic groups. The findings of the 16 investigations reviewed suggest that there are as yet unidentified factors - genetic, environmental or both - which are responsible for familial clustering of coronary heart disease, apart from the three main risk factors (serum lipids, blood pressure, smoking) and diabetes. Future research must put greater emphasis on studies of families rather than individuals and on closer collaboration between epidemiologists and geneticists, in order to fill these gaps in knowledge. It is likely that the individual predisposition to coronary heart disease is due in part to genetic influences which remain to be discovered in the course of such studies. They would help in identifying susceptible person in the population with greater precision than is now possible. The "high-risk strategy" of coronary heart disease prevention will become more efficient as more specific and sensitive tests of disease prediction are developed. In the meantime, preventive programmes must be put into action on the basis of what is already known, on the level of both the high-risk and the community-wide mass strategy.

  5. Plasma triglycerides and cardiovascular events in the Treating to New Targets and Incremental Decrease in End-Points through Aggressive Lipid Lowering trials of statins in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Faergeman, Ole; Holme, Ingar; Fayyad, Rana

    2009-01-01

    We determined the ability of in-trial measurements of triglycerides (TGs) to predict new cardiovascular events (CVEs) using data from the Incremental Decrease in End Points through Aggressive Lipid Lowering (IDEAL) and Treating to New Targets (TNT) trials. The trials compared atorvastatin 80 mg...

  6. Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: ''High-risk'' anatomy and its clinical relevance

    International Nuclear Information System (INIS)

    Krupinski, Maciej; Urbanczyk-Zawadzka, Malgorzata; Laskowicz, Bartosz; Irzyk, Malgorzata; Banys, Robert; Klimeczek, Piotr; Gruszczynska, Katarzyna; Baron, Jan

    2014-01-01

    The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up. A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus. Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p < 0.001), intramural course (15 vs. 3; p < 0.001) and interarterial course (11 vs. 0; p < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3; p = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4; p = NS). High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx. (orig.)

  7. Multi-day activity scheduling reactions to planned activities and future events in a dynamic model of activity-travel behavior

    NARCIS (Netherlands)

    Nijland, L.; Arentze, T.A.; Timmermans, H.J.P.

    2014-01-01

    Modeling multi-day planning has received scarce attention in activity-based transport demand modeling so far. However, new dynamic activity-based approaches are being developed at the current moment. The frequency and inflexibility of planned activities and events in activity schedules of

  8. Multi-Day Activity Scheduling Reactions to Planned Activities and Future Events in a Dynamic Model of Activity-Travel Behavior

    NARCIS (Netherlands)

    Nijland, L.; Arentze, T.; Timmermans, H.

    2014-01-01

    Modeling multi-day planning has received scarce attention in activity-based transport demand modeling so far. However, new dynamic activity-based approaches are being developed at the current moment. The frequency and inflexibility of planned activities and events in activity schedules of

  9. Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease

    NARCIS (Netherlands)

    Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A.; Kappelle, L. Jaap; de Borst, Gert Jan; Cramer, Maarten J.; Visseren, Frank L.J.; Aboyans, Victor; Westerink, Jan

    2017-01-01

    Background Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and

  10. Green is the future of chemistry : report of Taminco’s second Green Footsteps Event at the i-SUP 2012

    NARCIS (Netherlands)

    Noël, T.

    2012-01-01

    At the third edition of the international conference "Innovation for Sustainable Production 2012" (i-SUP 2012) in Bruges (Belgium), Taminco’s second Green Footsteps Event was held (May 7, 2012) [1]. The aim of this meeting is to create an open innovation platform in order to stimulate creative

  11. Multi-day activity scheduling reactions to planned activities and future events in a dynamic agent-based model of activity-travel behavior

    NARCIS (Netherlands)

    Nijland, E.W.L.; Arentze, T.A.; Timmermans, H.J.P.

    2009-01-01

    Modeling multi-day planning has received scarce attention today in activity-based transport demand modeling. Elaborating and combining previous work on event-driven activity generation, the aim of this paper is to develop and illustrate an extension of a need-based model of activity generation that

  12. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  13. [Coronary stents: 30 years of medical progress].

    Science.gov (United States)

    Silvain, Johanne; Cayla, Guillaume; Collet, Jean-Philippe; Fargeot, Catherine; Montalescot, Gilles

    2014-03-01

    The history of interventional cardiology has been marked by several technologic revolutions since the late 1970s. The first key step was the use of inflatable balloon angioplasty as an alternative to CABG surgery for coronary revascularization, followed by intracoronary delivery of bare metal stent (BMS) and drug eluting stents (DES) to drastically reduce intracoronary restenosis observed with BMS. Improved stents platforms and polymers (absorbable or biocompatible) led to a dramatic reduction in the rate of late stent thrombosis. Self-expanding stents are now available to improve stent a position especially in acute myocardial infarction. The emergence of new fully bioabsorbable stents that can be combined with antiproliferative drugs is the ongoing revolution. A new generation of stents is continuously improving and likely to become the ideal stent for coronary revascularization in the near future. © 2014 médecine/sciences – Inserm.

  14. Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk prediction models.

    Science.gov (United States)

    Krikke, M; Hoogeveen, R C; Hoepelman, A I M; Visseren, F L J; Arends, J E

    2016-04-01

    The aim of the study was to compare the predictions of five popular cardiovascular disease (CVD) risk prediction models, namely the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) model, the Framingham Heart Study (FHS) coronary heart disease (FHS-CHD) and general CVD (FHS-CVD) models, the American Heart Association (AHA) atherosclerotic cardiovascular disease risk score (ASCVD) model and the Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) model. A cross-sectional design was used to compare the cumulative CVD risk predictions of the models. Furthermore, the predictions of the general CVD models were compared with those of the HIV-specific D:A:D model using three categories ( 20%) to categorize the risk and to determine the degree to which patients were categorized similarly or in a higher/lower category. A total of 997 HIV-infected patients were included in the study: 81% were male and they had a median age of 46 [interquartile range (IQR) 40-52] years, a known duration of HIV infection of 6.8 (IQR 3.7-10.9) years, and a median time on ART of 6.4 (IQR 3.0-11.5) years. The D:A:D, ASCVD and SCORE-NL models gave a lower cumulative CVD risk, compared with that of the FHS-CVD and FHS-CHD models. Comparing the general CVD models with the D:A:D model, the FHS-CVD and FHS-CHD models only classified 65% and 79% of patients, respectively, in the same category as did the D:A:D model. However, for the ASCVD and SCORE-NL models, this percentage was 89% and 87%, respectively. Furthermore, FHS-CVD and FHS-CHD attributed a higher CVD risk to 33% and 16% of patients, respectively, while this percentage was D:A:D, ASCVD and SCORE-NL models. This could have consequences regarding overtreatment, drug-related adverse events and drug-drug interactions. © 2015 British HIV Association.

  15. Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting.

    Science.gov (United States)

    Singh, Amitoj; Agrawal, Sahil; Gargya, Sanchita; Saluja, Sabir; Kumar, Akshat; Kumar, Abhishek; Kalra, Kartik; Thind, Munveer; Saluja, Sajeev; Stone, Lauren E; Ali, Farhan; Duarte-Chavez, Rodrigo; Marchionni, Christine; Sholevar, Farhad; Shirani, Jamshid; Nanda, Sudip

    2017-01-01

    Post traumatic stress disorder is a psychiatric disease that is usually precipitated by life threatening stressors. Myocardial infarction, especially in the young can count as one such event. The development of post traumatic stress after a coronary event not only adversely effects psychiatric health, but leads to increased cardiovascular morbidity and mortality. There is increasing evidence that like major depression, post traumatic stress disorder is also a strong coronary risk factor. Early diagnosis and treatment of this disease in patients with acute manifestations of coronary artery disease can improve patient outcomes.

  16. Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Son V Pham

    2010-09-01

    Full Text Available Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI for acute coronary syndrome (ACS, both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients

  17. Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2014-01-01

    Full Text Available Coronary computed tomography angiography (CCTA has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

  18. Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes

    NARCIS (Netherlands)

    Aengevaeren, Vincent L; Mosterd, Arend; Braber, Thijs L; Prakken, Niek H J; Doevendans, Pieter A; Grobbee, Diederick E; Thompson, Paul D; Eijsvogels, Thijs M H; Velthuis, Birgitta K

    2017-01-01

    BACKGROUND: Higher levels of physical activity are associated with a lower risk of cardiovascular events. Nevertheless, there is debate on the dose-esponse relationship of exercise and cardiovascular disease outcomes and whether high volumes of exercise may accelerate coronary atherosclerosis. We

  19. Quality of medical management in coronary artery disease.

    Science.gov (United States)

    Al Shammeri, Owayed; Stafford, Randall S; Alzenaidi, Ahlam; Al-Hutaly, Bushra; Abdulmonem, Alaa

    2014-01-01

    Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure investment in strategies to achieve OMT in these high-risk patients.

  20. Detecting Periprocedural Myocardial Infarction in Contemporary Percutaneous Coronary Intervention Trials

    NARCIS (Netherlands)

    Spitzer, Ernest; de Vries, Ton; Cavalcante, Rafael; Tuinman, Marieke; Rademaker-Havinga, Tessa; Alkema, Maaike; Morel, Marie-Angele; Soliman, Osama I.; Onuma, Yoshinobu; van Es, Gerrit-Anne; Tijssen, Jan G. P.; McFadden, Eugene; Serruys, Patrick W.

    2017-01-01

    This study sought to investigate the differences in detecting (e.g., triggering) periprocedural myocardial infarction (PMI) among 3 current definitions. PMI is a frequent component of primary endpoints in coronary device trials. Identification of all potential suspected events is critical for