Shared Genetic Architecture in the Relationship between Adult Stature and Subclinical Coronary Artery Atherosclerosis

Science.gov (United States)

Cassidy-Bushrow, Andrea E.; Bielak, Lawrence F.; Sheedy, Patrick F.; Turner, Stephen T.; Chu, Julia S.; Peyser, Patricia A.

2011-01-01

Background Short stature is associated with increased risk of coronary heart disease (CHD); although the mechanisms for this relationship are unknown, shared genetic factors have been proposed. Subclinical atherosclerosis, measured by coronary artery calcification (CAC), is associated with CHD events and represents part of the biological continuum to overt CHD. Many molecular mechanisms of CAC development are shared with bone growth. Thus, we examined whether there was evidence of shared genes (pleiotropy) between adult stature and CAC. Methods 877 asymptomatic white adults (46% men) from 625 families in a community-based sample had computed tomography measures of CAC. Pleiotropy between height and CAC was determined using maximum-likelihood estimation implemented in SOLAR. Results Adult height was significantly and inversely associated with CAC score (P=0.01). After adjusting for age, sex, and CHD risk factors, the estimated genetic correlation between height and CAC score was -0.37 and was significantly different than 0 (P=0.001) and -1 (P<0.001). The environmental correlation between height and CAC score was 0.60 and was significantly different than 0 (P=0.024). Conclusions Further studies of shared genetic factors between height and CAC may provide important insight into the complex genetic architecture of CHD, in part through increased understanding of the molecular pathways underlying the process of both normal growth and disease development. Bivariate genetic linkage analysis may provide a powerful mechanism for identifying specific genomic regions associated with both height and CAC. PMID:21937044

Sarcopenia, but not excess weight or increased caloric intake, is associated with coronary subclinical atherosclerosis in the very elderly.

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Campos, Alessandra M; Moura, Filipe A; Santos, Simone N; Freitas, Wladimir M; Sposito, Andrei C

2017-03-01

Excess weight is a widespread condition related to increased risk of coronary heart disease (CHD). Sarcopenia is a catabolic pathway common of the aging process and also associated with CHD. In the elderly, both changes occur concurrently and it remains unclear the relative contribution on CHD risk. We aimed to investigate whether sarcopenia, excess weight, or both are associated with subclinical atherosclerosis and/or endothelial dysfunction in very elderly individuals. We performed a cross-sectional study of cohort enrolled individuals, aged 80 years or older (n = 208), who had never manifested cardiovascular diseases. Blood tests, medical and nutritional evaluations, cardiac computed tomography, flow-mediated dilation (FMD) and physical performance tests were obtained at the study admission. Odds ratio (OR) was calculated by multivariate regression models using coronary calcium score (CCS) categories and FMD as dependent variables. Adjustment for potential confounders was done. Muscle mass, but not fatty mass, was inversely associated with CCS categories [OR:2.54(1.06-6.06); p = 0.018]. The lowering of gait speed was negatively related to CCS>100 [OR:2.36 (1.10-5.06); p = 0.028] and skeletal muscle index was directly associated with FMD [OR:5.44 (1.22-24.24); p = 0.026]. Total caloric intake was positively related to fatty mass [OR:2.71 (1.09-6.72); p = 0.031], but was not related to CCS. This study reveals that sarcopenia - comprised by reduction of muscle mass and its strength - is associated with subclinical atherosclerosis and endothelial dysfunction. Surprisingly, the excess of fatty mass seems not to be related to atherosclerotic burden in very elderly individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

Interaction between smoking and depressive symptoms with subclinical heart disease in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Science.gov (United States)

Carroll, Allison J; Carnethon, Mercedes R; Liu, Kiang; Jacobs, David R; Colangelo, Laura A; Stewart, Jesse C; Carr, J Jeffrey; Widome, Rachel; Auer, Reto; Hitsman, Brian

2017-02-01

Evaluate whether smoking exposure and depressive symptoms accumulated over 25 years are synergistically associated with subclinical heart disease, measured by coronary artery calcification (CAC). Participants (baseline: 54.5% women; 51.5% Black; age range = 18-30 years) were followed prospectively from 1985 to 2010 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking status was queried yearly from Year 0 to Year 25 to compute packyears of smoking exposure. Depressive symptoms were measured on the Center for Epidemiologic Studies Depression (CES-D) scale every 5 years to compute cumulative scores from Year 5 to Year 25. A three-level multinomial logistic regression was used to evaluate the association between cumulative smoking, cumulative depressive symptoms, and their interaction with moderate-risk CAC (score 1-99) and higher-risk CAC (score ≥100) compared with no CAC (score = 0) at Year 25. Models were adjusted for sociodemographic, clinical, and behavioral covariates. Among 3,189 adults, the cumulative Smoking × Depressive Symptoms interaction was not significant for moderate-risk CAC (p = .057), but was significant for higher-risk CAC (p = .001). For adults with a 30-packyear smoking history, average CES-D scores 2, 10, and 16 were, respectively, associated with odds ratios (95% confidence intervals) 3.40 (2.36-4.90), 4.82 (3.03-7.66), and 6.25 (3.31-11.83) for higher-risk CAC (all ps < .05). Cumulative smoking exposure and cumulative depressive symptoms have a synergistic association with subclinical heart disease, where higher lifetime smoking exposure and depressive symptoms are associated with greater odds of CAC. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Migraine and subclinical atherosclerosis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

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Goulart, Alessandra C; Santos, Itamar S; Bittencourt, Márcio S; Lotufo, Paulo A; Benseñor, Isabela M

2016-08-01

The relationship between migraine and coronary heart disease (CHD) remains controversial. We aimed to investigate the association of subclinical atherosclerosis and migraine with or without aura compared to a non-migraine subgroup (reference) in a large Brazilian multicentric cohort study, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Migraine diagnostic was based on International Headache Society criteria, and aura symptoms were validated by a medical doctor in a sub-sample of the ELSA-Brasil, who also underwent coronary artery calcium score (CAC) and carotid intima-media thickness (C-IMT) evaluations. Subclinical atherosclerosis indexes (CAC and C-IMT) were analyzed as dependent variables and migraine (all, with aura, without aura) as an independent variable in the linear and multinomial logistic regression models adjusted for possible confounders. Of 3217 ELSA participants free from CVD at baseline, we found a migraine frequency of 11.9% (5.1% with aura and 6.8% without aura). Overall, migraineurs were mostly women, younger and had lower frequency of CV risk factors, such as hypertension, diabetes and low HDL-cholesterol, compared to non-migraineurs. The strongest inverse correlation between migraine and subclinical atherosclerosis was verified with CAC score. However, all associations lost their significance after multivariate adjustment. In this cross-sectional evaluation of the ELSA study, migraine was not associated with subclinical atherosclerosis, regardless of aura symptoms. © International Headache Society 2015.

Association of Television Viewing Time with Body Composition and Calcified Subclinical Atherosclerosis in Singapore Chinese.

Science.gov (United States)

Nang, Ei Ei Khaing; van Dam, Rob M; Tan, Chuen Seng; Mueller-Riemenschneider, Falk; Lim, Yi Ting; Ong, Kai Zhi; Ee, Siqing; Lee, Jeannette; Tai, E Shyong

2015-01-01

Sedentary behavior such as television viewing may be an independent risk factor for coronary heart disease. However, few studies have assessed the impact of television viewing time on coronary artery calcification and it remains unclear how body fat contributes to this relationship. The aim of this study is to evaluate the association between television viewing time and subclinical atherosclerosis and whether effects on visceral or subcutaneous fat may mediate any associations observed. This was a cross-sectional study of 398 Chinese participants (192 men and 206 women) from Singapore prospective study. Participants were free from known cardiovascular diseases and underwent interview, health screening, computed tomography scans of coronary arteries and abdomen. Spearman's correlation was used to test the correlation between television viewing time, physical activity, body composition and abdominal fat distribution. The association between television viewing time and subclinical atherosclerosis was assessed by multiple logistic regression analysis. In men, television viewing time was significantly correlated with higher body fat mass index, percent body fat, subcutaneous and visceral fat. These associations were in the same direction, but weaker and not statistically significant in women. Television viewing time (hours/day) was associated with subclinical atherosclerosis in men (odds ratio: 1.41, 95% CI: 1.03-1.93) but no significant association was observed in women (odds ratio: 0.88, 95% CI: 0.59-1.31) after adjusting for potential socio-demographic and lifestyle confounders. Further adjustments for biological factors did not affect these associations. Television viewing time was associated with greater adiposity and higher subcutaneous and visceral fat in men. TV viewing time was also associated with subclinical atherosclerosis in men and the potential mechanisms underlying this association require further investigation.

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...

Association of Television Viewing Time with Body Composition and Calcified Subclinical Atherosclerosis in Singapore Chinese.

Directory of Open Access Journals (Sweden)

Ei Ei Khaing Nang

Full Text Available Sedentary behavior such as television viewing may be an independent risk factor for coronary heart disease. However, few studies have assessed the impact of television viewing time on coronary artery calcification and it remains unclear how body fat contributes to this relationship. The aim of this study is to evaluate the association between television viewing time and subclinical atherosclerosis and whether effects on visceral or subcutaneous fat may mediate any associations observed.This was a cross-sectional study of 398 Chinese participants (192 men and 206 women from Singapore prospective study. Participants were free from known cardiovascular diseases and underwent interview, health screening, computed tomography scans of coronary arteries and abdomen. Spearman's correlation was used to test the correlation between television viewing time, physical activity, body composition and abdominal fat distribution. The association between television viewing time and subclinical atherosclerosis was assessed by multiple logistic regression analysis.In men, television viewing time was significantly correlated with higher body fat mass index, percent body fat, subcutaneous and visceral fat. These associations were in the same direction, but weaker and not statistically significant in women. Television viewing time (hours/day was associated with subclinical atherosclerosis in men (odds ratio: 1.41, 95% CI: 1.03-1.93 but no significant association was observed in women (odds ratio: 0.88, 95% CI: 0.59-1.31 after adjusting for potential socio-demographic and lifestyle confounders. Further adjustments for biological factors did not affect these associations.Television viewing time was associated with greater adiposity and higher subcutaneous and visceral fat in men. TV viewing time was also associated with subclinical atherosclerosis in men and the potential mechanisms underlying this association require further investigation.

Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort

DEFF Research Database (Denmark)

Fernández-Friera, Leticia; Peñalvo, José L; Fernández-Ortiz, Antonio

2015-01-01

age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque...

Unstable Angina with Normal Coronary Angiography in Hyperthyroidism: A Case Report

OpenAIRE

Tsung-Hsien Lin; Ho-Ming Su; Wen-Chol Voon; Wen-Ter Lai; Sheng-Hsiung Sheu

2005-01-01

Hyperthyroidism is associated with an increase in myocardial oxygen consumption that, due to an imbalance of oxygen demand and supply, can cause angina. However, subclinical hyperthyroidism rarely presents as chest pain in the resting state. Herein, we present a case of subclinical hyperthyroidism involving a 58-year-old male who complained of frequent chest tightness and typical electrocardiographic changes while in a resting state. Coronary angiography showed no significant lesion. Laborato...

Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease

International Nuclear Information System (INIS)

Wahl, Stefanie; Möhlenkamp, Stefan; Erbel, Raimund; Moebus, Susanne; Andrich, Silke; Stang, Andreas; Jöckel, Karl-Heinz; Dragano, Nico

2013-01-01

A parental history of premature coronary heart disease (CHD) is an established risk factor for CHD events in descendants. The study aim was to investigate whether subclinical coronary artery calcification (CAC) differs between asymptomatic individuals (a) without a parental CHD history, (b) with a parental history and (c) without knowledge of parental CHD history. The inclusion of individuals without knowledge of parental CHD history is a new approach. We also differentiated between CHD of mother and father to gain insight into their individual contributions. Data was obtained for 4,301 subjects aged 45–75 years free of overt CHD from the baseline screening of the population-based Heinz Nixdorf Recall study. CAC, measured by electron-beam computed tomography, was modeled conducting logistic regressions. Model 1 included family history, Model 2 was adjusted for age (and gender) and Model 3 added common CHD risk factors. The CAC score was dichotomized using the age and sex-specific 75th percentile. The odds ratio (OR) for CAC ≥ age and sex-specific 75th percentile was 1.33 among individuals with parental premature CHD history (95 % confidence interval [95 %CI]: 1.08, 1.63), which did not change after full adjustment (OR 1.40, 95 %CI: 1.13, 1.74). Individuals with an unknown biological father or mother had a high chance of elevated CAC scores (fully adjusted; father: OR 1.38, 95 %CI: 1.01, 1.90, mother: OR 1.86, 95 %CI: 0.90, 3.84) compared to the reference group. The current study showed an association between parental CHD history and CAC independent of common CHD risk factors. This association affirms the use of parental CHD history in cardiovascular risk assessment among asymptomatic adults in routine practice. The observation that individuals who did not know their mother or father are prone to increased CAC scores needs further confirmation in large scale studies.

Subclinical hypothyroidism has little influences on muscle mass or strength in elderly people.

Science.gov (United States)

Moon, Min Kyong; Lee, You Jin; Choi, Sung Hee; Lim, Soo; Yang, Eun Joo; Lim, Jae-Young; Paik, Nam-Jong; Kim, Ki Woong; Park, Kyong Soo; Jang, Hak C; Cho, Bo Youn; Park, Young Joo

2010-08-01

Sarcopenia, the age-related decline in muscle mass, affects the muscle strength and muscle quality, and these changes decrease functional capacity. The prevalence of thyroid dysfunction increases with age, and changes in thyroid hormone level lead to neuromuscular deficits. We investigated the effects of subclinical hypothyroidism on the muscle mass, strength or quality in elderly people. One thousand one hundred eighteen subjects aged > or = 65 yr were randomly selected from a local population and classified into a euthyroid (280 men and 358 women), subclinically hypothyroid (61 men and 75 women), or overtly hypothyroid (7 men and 16 women) group. Although women with subclinical hypothyroidism had a higher prevalence of sarcopenia, defined according to the ratio of appendicular skeletal muscle mass to the square of height, muscle mass, strength or quality did not differ in relation to thyroid status in men or in women. Multivariate analysis including age, diabetes, hypertension, acute coronary event, alcohol, smoking, presence of pain, physical activity score, and lipid profile, showed that thyroid-stimulating hormone level was not associated with muscle mass, strength or quality. In conclusion, subclinical hypothyroidism has little influences on muscle mass, strength or quality, and may not be associated with sarcopenia.

Subclinical Hypothyroid

Directory of Open Access Journals (Sweden)

Mohammad Reza Kalantar Hormozi

2011-04-01

Full Text Available Background: subclnical hypothyroid (SCH, defined by a normal total or free T4 level and a midly Elevated TSH, is common in adults. Subclinical hypothyroid is a risk factor for developing hypothyroidism complication . the goal of screening is to identify and treatment patients with sublinical hypothyroid before they develop these complication. Methods: The sample size of this study was the articles indexed in pubmed,ovid, tripdatabase, new spring link black coehrane, Elsevirer, Embase and contained the terms subclinical hypothyroid, Anti-tpo, Thyrotropin, levothyroxine trapy. Results: 831 articles were found that 75 articles were investigated for this issue. The results are discussed under. The subtile such as subclinical hypothyroid, screening for subclinical hypothyroid, Indication of treatment of Subclinical hypothyroid. Conclusion: In this summary, we tried to review the current literature about definition, Indection of screening and treatment of subclinical hypothyroid and reach a comprehensive guidline for practical significance of this subject in routines practice.

Psychological distress, cortisol stress response and subclinical coronary calcification

NARCIS (Netherlands)

Seldenrijk, A.; Hamer, M.; Lahiri, A.; Penninx, B.W.J.H.; Steptoe, A.

2012-01-01

Objectives: Poor mental health has been associated with coronary heart disease (CHD). One hypothesized underlying mechanism is hypothalamus pituitary adrenal axis dysfunction. We examined the associations between psychological distress, cortisol response to laboratory-induced mental stress and

Herpes simplex virus type 2 (HSV-2) as a coronary atherosclerosis risk factor in HIV-infected men: multicenter AIDS cohort study.

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Hechter, Rulin C; Budoff, Matthew; Hodis, Howard N; Rinaldo, Charles R; Jenkins, Frank J; Jacobson, Lisa P; Kingsley, Lawrence A; Taiwo, Babafemi; Post, Wendy S; Margolick, Joseph B; Detels, Roger

2012-08-01

We assessed associations of herpes simplex virus types 1 and 2 (HSV-1 and -2), cytomegalovirus (CMV), and human herpesvirus 8 (HHV-8) infection with subclinical coronary atherosclerosis in 291 HIV-infected men in the Multicenter AIDS Cohort Study. Coronary artery calcium (CAC) was measured by non-contrast coronary CT imaging. Markers for herpesviruses infection were measured in frozen specimens collected 10-12 years prior to case identification. Multivariable logistic regression models and ordinal logistic regression models were performed. HSV-2 seropositivity was associated with coronary atherosclerosis (adjusted odds ratio [AOR]=4.12, 95% confidence interval [CI]=1.58-10.85) after adjustment for age, race/ethnicity, cardiovascular risk factors, and HIV infection related factors. Infection with a greater number of herpesviruses was associated with elevated CAC levels (AOR=1.58, 95% CI=1.06-2.36). Our findings suggest HSV-2 may be a risk factor for subclinical coronary atherosclerosis in HIV-infected men. Infection with multiple herpesviruses may contribute to the increased burden of atherosclerosis. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Unstable angina with normal coronary angiography in hyperthyroidism: a case report.

Science.gov (United States)

Lin, Tsung-Hsien; Su, Ho-Ming; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

2005-01-01

Hyperthyroidism is associated with an increase in myocardial oxygen consumption that, due to an imbalance of oxygen demand and supply, can cause angina. However, subclinical hyperthyroidism rarely presents as chest pain in the resting state. Herein, we present a case of subclinical hyperthyroidism involving a 58-year-old male who complained of frequent chest tightness and typical electrocardiographic changes while in a resting state. Coronary angiography showed no significant lesion. Laboratory data showed that the patient suffered from hyperthyroidism, for which he was successfully treated with anti-thyroid agents. We are reminded that typical chest pain might be the first symptom of hyperthyroidism.

[Subclinical thyroid diseases].

Science.gov (United States)

Zamrazil, V

2007-01-01

Subclinical thyroids disease (STD) is recently defined term in clinical thyroidology, which includes mainly functional disorders. Basic diagnostic signs are: normal values of thyroid hormones (fT4, fT3) and elevated TSH level (subclinical hypothyroidism) or suppresed TSH level (subclinical hyperthyroidism). In a category of STD may be included subclinical autoimunne thyroiditis (elevated level of thyroid antigens antibodies and/or hypoechogenity in sonographic screen, increased volume of the thyroid without clinical symptoms and/or autoimminity) and microscopic lesions of papillary thyroid carcinoma. Subclinical hypothyroidism may be dangerous for tendency to development of manifest hypothyroidism and for risk of disorders of lipid profile and development of atherosclerosis and its organ complication (esp. myocardial infarction). Subclinical hyperthyroidism is a risk factor of cardiac arythmias and probably can increase a risk of cardiovascular mortality) as well for osteoporosis (esp. in peri- and post-climacteric women), and last but not least for degenerative diseases of brain (?). Indication of treatment of STD is a matter of controversies. Recomendations of experts, varied from "no therapy, monitoring only" to "treat always". Treatment of risk groups (esp. pregnant women) is probably nowadays a most rationale recommendations since results of sofisticated prospective studies will be available.

Dyslipidemia in subclinical hypothyroidism

OpenAIRE

Čaparević Zorica; Bojković Gradimir; Stojanović Dragoš Lj.; Ilić Vesna

2003-01-01

Introduction Subclinical hypothyroidism is defined as an increased serum TSH and normal serum FT4 concentration. In subclinical hypothyroidism, thyroid peroxidase and thyroglobulin antibodies are frequently present. Subclinical hypothyroidism may have endogenous or exogenous causes. The prevalence of subclinical hypothyroidism is rather high. The number of patients progressing to overt hypothyroidism may be higher. These patients may be asymptomatic, or have only mild symptoms or a single sym...

Cardiovascular risk and subclinical cardiovascular disease in polycystic ovary syndrome.

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Bajuk Studen, Katica; Jensterle Sever, Mojca; Pfeifer, Marija

2013-01-01

In addition to its effects on reproductive health, it is now well recognized that polycystic ovary syndrome (PCOS) is a metabolic disorder, characterized by decreased insulin sensitivity which leads to an excess lifetime risk of type 2 diabetes and cardiovascular disease. PCOS patients are often obese, hypertensive, dyslipidemic and insulin resistant; they have obstructive sleep apnea and have been reported to have higher aldosterone levels in comparison to normal healthy controls. These are all components of an adverse cardiovascular risk profile. Many studies exploring subclinical atherosclerosis using different methods (flow-mediated dilatation, intima media thickness, arterial stiffness, coronary artery calcification) as well as assessing circulating cardiovascular risk markers, point toward an increased cardiovascular risk and early atherogenesis in PCOS. The risk and early features of subclinical atherosclerosis can be reversed by non-medical (normalization of weight, healthy lifestyle) and medical (metformin, thiazolidinediones, spironolactone, and statins) interventions. However, the long-term risk for cardiovascular morbidity and mortality as well as the clinical significance of different interventions still need to be properly addressed in a large prospective study. Copyright © 2013 S. Karger AG, Basel.

The debate on treating subclinical hypothyroidism

Science.gov (United States)

Tng, Eng Loon

2016-01-01

Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH. PMID:27779276

The debate on treating subclinical hypothyroidism.

Science.gov (United States)

Tng, Eng Loon

2016-10-01

Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH. Copyright: © Singapore Medical Association.

Unstable Angina with Normal Coronary Angiography in Hyperthyroidism: A Case Report

Directory of Open Access Journals (Sweden)

Tsung-Hsien Lin

2005-01-01

Full Text Available Hyperthyroidism is associated with an increase in myocardial oxygen consumption that, due to an imbalance of oxygen demand and supply, can cause angina. However, subclinical hyperthyroidism rarely presents as chest pain in the resting state. Herein, we present a case of subclinical hyperthyroidism involving a 58-year-old male who complained of frequent chest tightness and typical electrocardiographic changes while in a resting state. Coronary angiography showed no significant lesion. Laboratory data showed that the patient suffered from hyperthyroidism, for which he was successfully treated with anti-thyroid agents. We are reminded that typical chest pain might be the first symptom of hyperthyroidism.

[CARDIOREABILITATION PECULIARITIES AND CORRECTION OF VIOLATIONS OF SISTOLIC, DIASOLIC FUNCTION AND HEART RATE VARIABILITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND CORONARY ARTERY REVASCULARIZATION].

Science.gov (United States)

Shved, M; Tsuglevych, L; Kyrychok, I; Levytska, L; Boiko, T; Kitsak, Ya

2017-04-01

In patients with acute coronary syndrome (ACS) who underwent coronary arteries revascularization, violations of hemodynamics, metabolism and heart rate variability often develop in the postoperative period, therefore, the goal of the study was to establish the features of disturbances and the effectiveness of correction of left ventricular systolic and diastolic dysfunction and heart rate variability in stages of cardiorehabilitation in patients with acute coronary syndrome who underwent coronary arteries revascularization. The experimental group included 40 patients with ACS in the postoperative period who underwent balloon angioplasty and stenting of the coronary arteries (25 patients with ST-segment elevation ACS and 15 patients without ST-segment elevation ACS). The age of examined patients was 37 to 74 years, an average of 52.6±6.7 years. The control group consisted of 20 patients, comparable in age and clinico-laboratory manifestations of ACS, who underwent drug treatment with direct anticoagulants, double antiplatelet therapy, β-blockers, ACE inhibitors and statins. Clinical efficacy of cardiorespiratory process in patients of both groups was assessed by the dynamics of general clinical symptoms and parameters of natriuretic propeptide, systolic and diastolic function of the left ventricle and heart rate variability. In the initial state, clinical and laboratory-instrumental signs of myocardial ischemia disappear in patients with ACS undergoing surgical revascularization of the coronary arteries, but clinical and subclinical manifestations of heart failure were diagnosed. The use of the accelerated program of cardiac rehabilitation already during the first month of studies leads to a decreasement of the signs of systolic and diastolic dysfunction, the level of NT-proBNP and improve in the variability of the heart rhythm wich significantly improves the life quality of patients with ACS. To monitor the effectiveness and safety of cardiac rehabilitation in

Identifying coronary artery disease in asymptomatic middle-aged sportsmen : The additional value of pulse wave velocity

NARCIS (Netherlands)

Braber, Thijs L.; Prakken, Niek H J; Mosterd, Arend; Mali, Willem P Th M; Doevendans, Pieter A F M; Bots, Michiel L.; Velthuis, Birgitta K.

2015-01-01

Background: Cardiovascular screening may benefit middle-aged sportsmen, as coronary artery disease (CAD) is the main cause of exercise-related sudden cardiac death. Arterial stiffness, as measured by pulse wave velocity (PWV), may help identify sportsmen with subclinical CAD. We examined the

Cardiovascular risk factors in patients with subclinical hypothyroidism

Directory of Open Access Journals (Sweden)

Pešić Milica

2007-01-01

Full Text Available Background/Aims. Overt hypothyroidism is disease associated with accelerated arteriosclerosis and coronary heart disease. Whether subclinical hypothyroidism (SH is associated with increased cardiovascular risk is contraversial. As SH is a high prevalence thyroid dysfunction, specially in older women, it is important to evaluate cardiovascular risk factors in these patients and that was the aim of this study. Methods. We examined 30 patients with SH and 20 healthy controls. Subclinical hypothireoidism was defined as an elevated thyrotropin (TSH (> 4.5 mU/L and normal free thyroxine (FT4 level. In all the participants we determined body mass index (BMI, blood pressure, TSH, FT4, antibodies to thyroid peroxidase, antibodies to thyroglobulin, total cholesterol, high density lipoprotein (HDL cholesterol, low density lipoprotein (LDL cholesterol, triglicerides, total cholesterol/HDL cholesterol ratio and LDL/HDL cholesterol ratio. Results. Mean BMI in patients with SH was significantly higher (p < 0.05, as well as diastolic blood pressure (p < 0.01 compared with the controls. Average levels of total cholesterol (5.40±0.62 vs 5.06±0.19 mmol/l, p < 0.01 and triglycerides (2.16±0.56 vs 1.89±0.24 mmol/l, p < 0.05 were also significantly higher in the group with SH. Individual analysis revealed that the percentage of patients with SH having borderline elevated total cholesterol (63.33%, hypertrigliceridemia (43.33% and elevated total cholesterol/HDL cholesterol ratio (26.67% were significantly higher than the percentage in the controls. No significant correlation between TSH and lipid parameters was detected. Conclusion. Subclinical hypothyroidism was associated with higher BMI, diastolic hypertension, higher total cholesterol and triglicerides levels and higher total cholesterol/HDL cholesterols ratio. This might increase the risk of accelerated arteriosclerosis in patients with SH.

[Subclinical hyperthyroidism: from diagnosis to treatment].

Science.gov (United States)

Corvilain, B

2012-09-01

Subclinical hyperthyroidism is a common clinical entity. Subclinical hyperthyroidism is defined as a serum TSH below the reference range but a normal T4 and T3 level in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional studies and longitudinal population-based studies demonstrate association between subclinical hyperthyroidism and risk of atrial fibrillation, osteoporosis and cardiovascular and global mortality. However, there are no randomized clinical trials answering the question whether long term-health outcomes are improved by the treatment of subclinical hyperthyroidism. Therefore in the absence of evidence for or against treatment of subclinical hyperthyroidism, it seems appropriate to follow algorithms that consider the level of TSH and the presence of risks factors (age > 65 years, osteoporosis, post menopause and cardiac disease).

The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol ELSA-Brasil).

Science.gov (United States)

Al Rifai, Mahmoud; Martin, Seth S; McEvoy, John W; Nasir, Khurram; Blankstein, Ron; Yeboah, Joseph; Miedema, Michael; Shea, Steven J; Polak, Joseph F; Ouyang, Pamela; Blumenthal, Roger S; Bittencourt, Marcio; Bensenor, Isabela; Santos, Raul D; Duncan, Bruce B; Santos, Itamar S; Lotufo, Paulo A; Blaha, Michael J

2018-07-01

The prevalence and correlates of subclinical atherosclerosis when low-density lipoprotein cholesterol (LDL-C) levels are low remain unclear. Therefore, we examined the association of cardiovascular risk factors and subclinical atherosclerosis among individuals with untreated LDL-C ELSA-Brasil) cohorts. To optimize accuracy, LDL-C was calculated by the validated Martin/Hopkins equation that uses an adjustable factor for the ratio of triglycerides to very low-density lipoprotein cholesterol. We defined subclinical atherosclerosis as a coronary artery calcium (CAC) score >0 in the combined cohort or common carotid intima media thickness (cIMT) in the 4 th quartile, using cohort-specific cIMT distributions at baseline. Logistic regression models examined the cross-sectional associations of cardiovascular risk factors and subclinical atherosclerosis. Among 9411 participants not on lipid lowering therapy, 263 (3%) had LDL-C ELSA: 57). Mean age in this population was 58 (SD 12) years, with 43% men, and 41% Black. The prevalence of CAC >0 in those with untreated LDL-C<70 mg/dL was 30%, and 18% were in 4th quartile of cIMT. In demographically adjusted models, only ever smoking was significantly associated with both CAC and cIMT. Similar results were obtained in risk factor-adjusted models (smoking: OR, 2.29; 95% CI, 1.10-4.80 and OR, 3.44; 95% CI, 1.41-8.37 for CAC and cIMT, respectively). Among middle-aged to older individuals with untreated LDL-C <70 mg/dL, subclinical atherosclerosis remains moderately common and is associated with cigarette smoking. Copyright © 2018 Elsevier B.V. All rights reserved.

Six controversial issues on subclinical Cushing's syndrome.

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Chiodini, Iacopo; Albani, Adriana; Ambrogio, Alberto Giacinto; Campo, Michela; De Martino, Maria Cristina; Marcelli, Giorgia; Morelli, Valentina; Zampetti, Benedetta; Colao, Annamaria; Pivonello, Rosario

2017-05-01

Subclinical Cushing's syndrome is a condition of hypercortisolism in the absence of signs specific of overt cortisol excess, and it is associated with an increased risk of diabetes, hypertension, fragility fractures, cardiovascular events and mortality. The subclinical Cushing's syndrome is not rare, being estimated to be between 0.2-2 % in the adult population. Despite the huge number of studies that have been published in the recent years, several issues remain controversial for the subclinical Cushing's syndrome screening, diagnosis and treatment. The Altogether to Beat Cushing's syndrome Group was founded in 2012 for bringing together the leading Italian experts in the hypercortisolism-related diseases. This document represents the Altogether to Beat Cushing's syndrome viewpoint regarding the following controversial issues on Subclinical Cushing's syndrome (SCS): (1) Who has to be screened for subclinical Cushing's syndrome? (2) How to screen the populations at risk? (3) How to diagnose subclinical Cushing's syndrome in patients with an adrenal incidentaloma? (4) Which consequence of subclinical Cushing's syndrome has to be searched for? (5) How to address the therapy of choice in AI patients with subclinical Cushing's syndrome? (6) How to follow-up adrenal incidentaloma patients with subclinical Cushing's syndrome surgically or conservatively treated? Notwithstanding the fact that most studies that faced these points may have several biases (e.g., retrospective design, small sample size, different criteria for the subclinical Cushing's syndrome diagnosis), we believe that the literature evidence is sufficient to affirm that the subclinical Cushing's syndrome condition is not harmless and that the currently available diagnostic tools are reliable for identifying the majority of individuals with subclinical Cushing's syndrome.

Clinical outcome of nonculprit plaque ruptures in patients with acute coronary syndrome in the PROSPECT study.

Science.gov (United States)

Xie, Yong; Mintz, Gary S; Yang, Junqing; Doi, Hiroshi; Iñiguez, Andrés; Dangas, George D; Serruys, Patrick W; McPherson, John A; Wennerblom, Bertil; Xu, Ke; Weisz, Giora; Stone, Gregg W; Maehara, Akiko

2014-04-01

The aim of this study was to report the frequency, patient and lesion-related characteristics, and outcomes of subclinical, nonculprit plaque ruptures in the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study. Plaque rupture and subsequent thrombosis is the most common cause of acute coronary syndrome (ACS). Secondary, subclinical, nonculprit plaque ruptures have been seen in both stable patients and patients with ACS; however, reports of the natural history of these secondary plaque ruptures are limited. After successful stenting in 697 patients with ACS, 3-vessel grayscale and intravascular ultrasound virtual histology (IVUS-VH) was performed in the proximal-mid segments of all 3 coronary arteries as part of a prospective multicenter study. Among 660 patients with complete IVUS data, 128 plaque ruptures were identified in 105 nonculprit lesions in 100 arteries from 93 patients (14.1%). Although the minimum lumen area (MLA) was similar, the plaque burden was significantly greater in nonculprit lesions with a plaque rupture compared with nonculprit lesions without a plaque rupture (66.0% [95% confidence interval: 64.5% to 67.4%] vs. 56.0% [95% confidence interval: 55.6% to 56.4%]; p PROSPECT]; NCT00180466). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients.

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Salmazo, Péricles Sidnei; Bazan, Silméia Garcia Zanati; Shiraishi, Flávio Gobbis; Bazan, Rodrigo; Okoshi, Katashi; Hueb, João Carlos

2018-04-09

AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p media thickness was higher in the HIV group than in controls (p media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.

Subclinical cardiovascular disease assessment and its relationship with cardiovascular risk SCORE in a healthy adult population: A cross-sectional community-based study.

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Mitu, Ovidiu; Roca, Mihai; Floria, Mariana; Petris, Antoniu Octavian; Graur, Mariana; Mitu, Florin

The aim of this study is to evaluate the relationship and the accuracy of SCORE (Systematic Coronary Risk Evaluation Project) risk correlated to multiple methods for determining subclinical cardiovascular disease (CVD) in a healthy population. This cross-sectional study included 120 completely asymptomatic subjects, with an age range 35-75 years, and randomly selected from the general population. The individuals were evaluated clinically and biochemical, and the SCORE risk was computed. Subclinical atherosclerosis was assessed by various methods: carotid ultrasound for intima-media thickness (cIMT) and plaque detection; aortic pulse wave velocity (aPWV); echocardiography - left ventricular mass index (LVMI) and aortic atheromatosis (AA); ankle-brachial index (ABI). SCORE mean value was 2.95±2.71, with 76% of subjects having SCORE <5. Sixty-four percent of all subjects have had increased subclinical CVD changes, and SCORE risk score was correlated positively with all markers, except for ABI. In the multivariate analysis, increased cIMT and aPWV were significantly associated with high value of SCORE risk (OR 4.14, 95% CI: 1.42-12.15, p=0.009; respectively OR 1.41, 95% CI: 1.01-1.96, p=0.039). A positive linear relationship was observed between 3 territories of subclinical CVD (cIMT, LVMI, aPWV) and SCORE risk (p<0.0001). There was evidence of subclinical CVD in 60% of subjects with a SCORE value <5. As most subjects with a SCORE value <5 have subclinical CVD abnormalities, a more tailored subclinical CVD primary prevention program should be encouraged. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

Pattern Of Altered Lipid Profile In Patients With Subclinical And Clinical Hypothyroidism And Its Correlation With Body Mass Index

International Nuclear Information System (INIS)

Humerah, S.; Siddiqui, A.; Khan, H. F.

2016-01-01

Objective: To compare the lipid profile of the subclinical and clinical hypothyroid patients and to evaluate the correlation between body mass index (BMI) and lipid profile in hypothyroidism. Study Design: Cross-sectional study. Place and Duration of Study: Islamic International Medical College, Riphah International University, Islamabad, and Citi Laboratory, Rawalpindi, from January to December 2013. Methodology: The subjects were selected through non-probability, purposive sampling. On the basis of thyroid profile, the subjects were divided into 3 groups: euthyroids (n=20), subclinical hypothyroids (n=50), and clinical hypothyroids (n=30). The blood of these subjects was then analyzed for lipid profile. Data was analyzed using SPSS version 18 statistical software. Result: Both hypothyroid groups showed altered lipid profile which was observed to be significantly raised when compared with the euthyroid subjects. Comparison of lipid profile in euthyroid, subclinical, and clinical hypothyroid groups showed significant differences by non-parametric tests (p < 0.05). An assessment of correlation of lipid profile with the BMI was found to be significant (p < 0.01). Conclusion: Hypothyroidism causes alteration of lipid profile. Clinical and subclinical hypothyroid patients have altered lipid profile as compared to euthyroids. Thyroid status monitoring is very important, since it can induce changes in lipid profile. Such dyslipidemic status is significant not only for the management of thyroid disorders but also for common diseases like obesity and coronary atherosclerosis in the population. (author)

Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block!

Science.gov (United States)

Ali, Shozab S; Oni, Ebenezer T; Warraich, Haider J; Blaha, Michael J; Blumenthal, Roger S; Karim, Adil; Shaharyar, Sameer; Jamal, Omar; Fialkow, Jonathan; Cury, Ricardo; Budoff, Matthew J; Agatston, Arthur S; Nasir, Khurram

2014-10-01

Patients with obstructive sleep apnea (OSA) have a high burden of cardiovascular disease (CVD) but a causal relationship between OSA and atherosclerotic CVD remains unclear. We systematically reviewed the literature analyzing the relationship. A review of the Medline database for studies noninvasively evaluating subclinical CVD in OSA was conducted. A total of fifty-two studies were included in this review. Across the studies the prevalence of atherosclerosis, as assessed by coronary artery calcification, carotid intima-media thickness, brachial artery flow-mediated dilation and pulse wave velocity was higher in patients with OSA and correlated with increasing severity and duration of OSA. This study shows OSA is an independent predictor of subclinical CVD as CVD is more likely to occur in patients with long standing and severe OSA. Further research is however necessary to identify specific OSA populations that would benefit from aggressive screening. Copyright © 2014 Elsevier Ltd. All rights reserved.

Increased risk of subclinical atherosclerosis associated with high visceral adiposity index in apparently healthy Korean adults: the Kangbuk Samsung Health Study.

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Park, Hye-Jeong; Kim, Jihyun; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

2016-09-01

The visceral adiposity index (VAI) is a mathematical tool that reflects a patient's visceral adiposity and insulin resistance. Recent studies have noted an association between VAI and cardiovascular event. We analyzed the association between VAI and coronary artery calcium score (CACS) in Korean adults. For 33,468 participants (mean age 42 yrs) in a health screening program, VAI was calculated using the following formulae: [waist circumference (WC)/{39.68 + (1.88 * body mass index (BMI))}] * (triglyceride/1.03) * {1.31/high-density lipoprotein cholesterol (HDL-C)} for men and [WC/{36.58 + (1.89 * BMI)}] * (triglyceride/0.81) * (1.52/HDL-C) for women. Coronary artery calcium scores were measured with multi-detector computed tomography. CACS was positively correlated with VAI (r = 0.027, p 0 as the dependent variable, subjects in the highest tertile of VAI (>1.777) had significantly increased odds ratio for CACS >0 compared to subjects in the lowest tertile (<0.967), even after adjusting for confounding variables, including BMI (OR 1.26, 95% CI 1.147-1.381). Subjects with high VAI had increased risk for subclinical atherosclerosis, as assessed by CACS. Key messages Recent studies have noted an association between visceral adiposity index (VAI) and cardiovascular event. Subjects with coronary artery calcification (CAC) showed significantly higher VAI compared to those without CAC. The subjects with high VAI showed increased odds ratio for CAC as compared to subjects with low VAI, suggesting high VAI reflects increased risk for subclinical atherosclerosis.

Associations of fibroblast growth factor 23 and fetuin-A with coronary plaque burden and plaque composition in young adults.

Science.gov (United States)

Akin, Fatih; Celik, Omer; Ayca, Burak; Altun, Ibrahim; Diker, Vesile Ornek; Byk, Ismail; Siriopol, Dimitrie; Covic, Adrian; Kanbay, Mehmet

2015-04-01

The total burden of subclinical coronary artery disease (CAD) is significant among young adults. Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality because of cardiovascular disease. The objective of the study was to evaluate the relationship between subclinical CAD and serum FGF-23 and fetuin-A concentrations among a population of young adults. A total of 241 subjects younger than 45 years who had undergone coronary computed tomographic angiography (CCTA) were included in the study. In 117 patients, the CCTA detected subclinical CAD; the rest of the patients had no CAD detected on CCTA. Serum FGF-23 and fetuin-A levels were significantly increased in the CAD patients as compared with the non-CAD patients (26.7 [interquartile range, 22.4-31.9] vs 15.7 [interquartile range, 13.2-18.1] pg/mL and 904.7 [interquartile range, 695.5-1021.6] vs 469.6 [331.4-660.5] mg/L, respectively; P < 0.001 for both). Furthermore, a positive correlation was identified between FGF-23 and fetuin-A levels and the total number of plaques (r = 0.21 and r = 0.28, respectively; P < 0.001 for both). In multivariate logistic regression analysis, age, smoking status, uric acid, FGF-23, and fetuin-A levels were found to be independently associated with the presence of CAD. The presence of subclinical CAD is independently associated with FGF-23 and fetuin-A and could be used as novel risk markers of cardiovascular disease in the asymptomatic young adult population.

Severity of nonalcoholic fatty liver disease is associated with subclinical cerebro-cardiovascular atherosclerosis risk in Korean men.

Science.gov (United States)

Lee, Jung Eun; Lee, Yong Jae; Chung, Soo Yoon; Cho, Hee Woo; Park, Byoung Jin; Jung, Dong Hyuk

2018-01-01

No studies have reported the relationship between nonalcoholic fatty liver disease (NAFLD) and concurrent cerebral artery and coronary artery atherosclerosis simultaneously. We aimed at determining whether NAFLD, as assessed by ultrasound, is associated with subclinical cerebro-cardio vascular atherosclerosis (CCVA) by multidetector-row computed tomography (MDCT), and high resolution-magnetic resonance angiography (HR-MRA). This cross-sectional study included men in the general Korean population aged 20-70 years. A total of 1,652 men participated in the study (normal, n = 835; mild-to-moderate NAFLD, n = 512; severe NAFLD, n = 305). The risk of subclinical CCVA was positively associated with age (odds ratio [OR] 1.068; 1.054-1.081, p < 0.001), body mass index (OR 1.120; 1.08 0-1.162, p < 0.001), hepatic enzyme levels (OR 1.012; 1.001-1.023, p = 0.027; OR 1.006; 1.001-1.012, p = 0.036), fasting glucose (OR 1.021; 1.015-1.027, p < 0.001), triglycerides (OR 1.002; 1.000-1.003, p = 0.016), hypertension (OR 2.836; 2.268-3.546, p < 0.001), and diabetes (OR 2.911; 2.137-3.964, p < 0.001). Also, high-density lipoprotein cholesterol was inversely associated with subclinical CCVA (OR 0.974; 0.965-0.982, p < 0.001). Compared with normal controls, the OR for subclinical CCVA after full adjustment was 1.46 in the mild-to-moderate NAFLD group (95% confidence interval [CI]: 1.10 to 1.93) and 2.04 in the severe NAFLD group (95% CI: 1.44 to 2.89). Our data show that NAFLD is common among Korean men, and NAFLD severity on ultrasonography is associated with subclinical CCVA, as assessed by MDCT, and HR-MRA.

Screening of subclinical hepatic encephalopathy

NARCIS (Netherlands)

Groeneweg, M; Moerland, W; Quero, J C; Hop, W C; Krabbe, P F; Schalm, S W

BACKGROUND/AIMS: Subclinical hepatic encephalopathy adversely affects daily functioning. The aim of this study was to determine which elements of daily life have predictive value for subclinical hepatic encephalopathy. METHODS: The study was performed in 179 outpatients with liver cirrhosis.

Update on subclinical hyperthyroidism.

Science.gov (United States)

Donangelo, Ines; Braunstein, Glenn D

2011-04-15

Subclinical hyperthyroidism is defined by low or undetectable serum thyroid-stimulating hormone levels, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (as in Graves disease or toxic nodular goiter), administration of thyroid hormone for treatment of malignant thyroid disease, or unintentional excessive thyroid hormone therapy. The rate of progression to overt hyperthyroidism is higher in persons who have suppressed thyroid-stimulating hormone levels compared with those who have low but detectable levels. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation in older adults, and with decreased bone mineral density in postmenopausal women; however, the effectiveness of treatment in preventing these conditions is unknown. There is lesser-quality evidence suggesting an association between subclinical hyperthyroidism and other cardiovascular effects, including increased heart rate and left ventricular mass, and increased bone turnover markers. Possible associations between subclinical hyperthyroidism and quality of life parameters, cognition, and increased mortality rates are controversial. Prospective randomized controlled trials are needed to address the effects of early treatment on potential morbidities to help determine whether screening should be recommended in the asymptomatic general population.

Subclinical organ damage and cardiovascular risk prediction

DEFF Research Database (Denmark)

Sehestedt, Thomas; Olsen, Michael H

2010-01-01

Traditional cardiovascular risk factors have poor prognostic value for individuals and screening for subclinical organ damage has been recommended in hypertension in recent guidelines. The aim of this review was to investigate the clinical impact of the additive prognostic information provided...... by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii...

Differential Association of Psychosocial Comorbidities With Subclinical Atherosclerosis in Rheumatoid Arthritis.

Science.gov (United States)

Liu, Ying L; Szklo, Moyses; Davidson, Karina W; Bathon, Joan M; Giles, Jon T

2015-10-01

Rheumatoid arthritis (RA) is associated with an elevated risk of cardiovascular disease (CVD) events and subclinical atherosclerosis, but the reasons for the excess risk are unclear. We explored whether psychosocial comorbidities, which may be associated with CVD in the general population, are differentially associated with subclinical atherosclerosis in RA compared to controls. Data were from a longitudinal cohort study of 195 RA patients and 1,073 non-RA controls. Using validated scales, heterogeneity in the associations of psychosocial measures (depression, stress, anxiety/anger, support, discrimination/hassles) with measures of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima-media thickness [IMT]/plaque) were compared in RA and non-RA groups using multivariable generalized linear models. Computed tomography and ultrasound were used to identify CAC and IMT/plaque, respectively. CAC >100 units was used to define moderate/severe CAC. In RA, per-unit higher anxiety scores (odds ratio [OR] 1.10, P = 0.029), anger scores (OR 1.14, P = 0.037), depressive symptoms (OR 3.41, P = 0.032), and caregiver stress (OR 2.86, P = 0.014) were associated with increased odds of CAC >100 units after adjustment for relevant covariates. These findings persisted despite adjustment for markers of inflammation (C-reactive protein and interleukin-6 levels) and were seen only in RA, not in controls (adjusted multiplicative interaction P = 0.001-0.077). In RA, job stress was associated with an increased risk of carotid plaque (adjusted OR = 3.21, P = 0.019), and increasing social support was associated with lower internal carotid IMT (adjusted P = 0.024). Depressive symptoms, stress, anger/anxiety, and social support may preferentially affect CVD risk in RA, and screening/treatment for psychosocial morbidities in RA may help ameliorate the additional CVD burden. © 2015, American College of Rheumatology.

Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers

DEFF Research Database (Denmark)

Rasmussen, Thomas; Køber, Lars; Pedersen, Jesper Holst

2013-01-01

Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk...... factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers....

Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Science.gov (United States)

de Miranda, E J F Peixoto; Bittencourt, M S; Staniak, H L; Sharovsky, R; Pereira, A C; Foppa, M; Santos, I S; Lotufo, P A; Benseñor, I M

2018-03-15

Data on the association between subclinical thyroid dysfunction and coronary artery disease (CAD) is scarce. We aimed to analyze the association between thyroid function and CAD using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (0.4-4.0 mIU/L, and normal free thyroxine, FT4, or 0.8 to 1.9 ng/dL), subclinical hypothyroidism (SCHypo; TSH>4.0 mIU/L and normal FT4), and subclinical hyperthyroidism (SCHyper; TSH4, and segment severity score (SSS) >4 of coronary arteries as the dependent variables, and quintiles of TSH and FT4 as the independent variables, adjusted for demographical data and cardiovascular risk factors. We included 767 subjects, median age 58 years (IQR=55-63), 378 (49.3%) women, 697 euthyroid (90.9%), 57 (7.4%) with SCHypo, and 13 (1.7%) with SCHyper. No association between TSH and FT4 quintiles and CAD prevalence was noted. Similarly, no association between TSH levels and the extent or severity of CAD, represented by SIS>4 and SSS>4 were seen. Restricting analysis to euthyroid subjects did not alter the results. TSH levels were not significantly associated with the presence, extent, or severity of CAD in a middle-aged healthy population.

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile.

Science.gov (United States)

Merghani, Ahmed; Maestrini, Viviana; Rosmini, Stefania; Cox, Andrew T; Dhutia, Harshil; Bastiaenan, Rachel; David, Sarojini; Yeo, Tee Joo; Narain, Rajay; Malhotra, Aneil; Papadakis, Michael; Wilson, Mathew G; Tome, Maite; AlFakih, Khaled; Moon, James C; Sharma, Sanjay

2017-07-11

Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P =0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01-1.15; P =0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC

Subclinical laminitis in dairy heifers.

Science.gov (United States)

Bradley, H K; Shannon, D; Neilson, D R

1989-08-19

By causing poorer horn quality, subclinical laminitis is considered to be a major predisposing cause of other hoof problems, particularly sole ulcers in newly calved heifers. In this study the hind hooves of 136 female Friesian/Holstein cattle aged between four months and two years were examined to discover at what age the signs of subclinical laminitis appeared. Sole haemorrhages were found in the hoof horn of calves as young as five months. The consistent finding of these lesions in heifers of all ages indicated that subclinical laminitis of varying degree was a common condition during the early growing period of young dairy heifers.

[Subclinical and manifested hypothyroidism as a consequence of thyroid autoimmune disease].

Science.gov (United States)

Milosević, Dragoslav P; Djurica, Snezana; Davidović, Mladen; Stević, Radmila; Rajić, Miodrag; Marković, Natasa

2005-10-01

Chronic thyroiditis (Hashimoto's disease) is a slowly developing persistent inflamation of the thyroid gland, which frequently leads to hypothyroidism. Some of the up-to-date knowledge about hypothyroidism, both subclinical and manifested, caused by autoimmune disease, was presented. Autoimmune thyroid gland disease can occur at any age, but predominantly affects women after periods of high emotional and physical stress or accidents, as well as during periods of hormonal changes. It can also develop in families, and having an autoimmune disease slightly increases the risk of developing another. This paper showed an increasing incidence of subclinical hypothyroidism (4.17%) in elderly, and, at the same time, the incidence of primary hypothyroidism accounting for 1%. It is very usefull to estimate the stimulated thyrotropin (TSH) response, as well as the value of fast, short time thyroid gland reserves, analyzed by T3 and T4 serum level at 60th minute after TRH stimulation. Treatment of choice for HT (hypothyroidism of any cause) is thyroid hormone replacement. Drug of choice is orally administered levothyroxine sodium, usually for life-time. The standard dose is 1.6-1.8 mcg/kg body weight per day, but is in most cases patient dependent. Elderly patients usually require smaller replacement dose of levothyroxine, sometimes less than 1 mcg/kg body weight per day with coronary dilatator at the same time.

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

"Subclinical" laminitis in dairy cattle.

Science.gov (United States)

Vermunt, J J

1992-12-01

In dairying countries worldwide, the economic importance of lameness in cattle is now recognised. Laminitis is regarded as a major predisposing factor in lameness caused by claw disorders such as white zone lesions, sole ulcer, and heel horn erosion. The existence of subclinical laminitis was first suggested in the late 1970s by Dutch workers describing the symptoms of sole haemorrhages and yellowish-coloured, soft sole horn. In an attempt to clarify some of the confusing and often conflicting terminology, the literature on laminitis is reviewed. Disturbed haemodynamics, in particular repeated or prolonged dilation of arteriovenous anastomoses, have been implicated in the pathogenesis of both equine and bovine laminitis. Some characteristics of the vascular system of the bovine claw which may be of importance in the pathophysiology of the subclinical laminitis syndrome are therefore discussed. Clinical observations suggest that subclinical laminitis is a multifactorial disease. The different factors that are or may be involved in its aetiology vary in complexity and severity according to the management protocol of the animals. The possible involvement of subclinical laminitis in claw lesions is assessed.

Value of Low Triiodothyronine and Subclinical Myocardial Injury for Clinical Outcomes in Chest Pain.

Science.gov (United States)

Lee, Young-Min; Ki, Young-Jae; Choi, Dong-Hyun; Kim, Bo-Bae; Shin, Byung Chul; Song, Heesang; Kim, Dong-Min

2015-11-01

Low triiodothyronine (T3) levels and subclinical myocardial injury may be associated with adverse cardiac and cerebrovascular (CCV) events in individuals without clinically apparent coronary heart disease (CHD). The aim of this study was to determine the associations of a low T3 level and subclinical myocardial injury with the development of adverse CCV events in individuals without clinically apparent CHD. T3 and high-sensitivity cardiac troponin T (hs-cTnT) levels were analyzed in 250 patients with chest pain free of CHD and heart failure. The primary end point was the composite of sudden cardiac death, ischemic stroke, newly developed atrial fibrillation, pericardial effusion and thrombosis. Throughout a mean follow-up of 15.6 months, the primary end point happened in 17 patients (6.8%). Kaplan-Meier analysis disclosed a notably higher overall occurrence rate in patients with hs-cTnT levels ≥0.014 ng/mL and in patients with T3 <60 ng/dL. An exaggerated hazard was observed in patients with combined high hs-cTnT and low T3 levels. After adjustment, the hazard ratio for overall events in patients with high hs-cTnT/low T3 versus normal hs-cTnT/T3 was 11.72 (95% confidence interval, 2.83-48.57; P = 0.001). In patients with chest pain without clinically obvious CHD, high hs-cTnT combined with low T3 was associated with adverse cardiac/CCV events and was an independent predictor of overall events even after adjustment. These data suggest the importance of systemic factors, such as low T3 syndrome, in the development of adverse cardiac/CCV events beyond advancing clinical atherosclerotic coronary disease in patients with chest pain.

Early detection of premature subclinical coronary atherosclerosis in systemic lupus erythematosus patients

Directory of Open Access Journals (Sweden)

Khaled Mohamed Said Othman

2013-12-01

Conclusion: Pre-menopausal SLE female patients free from clinical atherosclerotic vascular disease have an increased number of atherosclerotic plaques and CCS, which correlate positively with SLEDAI disease activity score, serum CRP, anticardiolipin antibodies, sICAM-1, E-Selectin, LDL level, total cholesterol level, and cumulative prednisone dose. In addition, we conclude that MDCT is a non-invasive, sensitive, reproducible, and reliable tool for accurate measurement of coronary calcification.

Subclinical Thyroid Dysfunction and Fracture Risk

DEFF Research Database (Denmark)

Blum, Manuel R; Bauer, Douglas C; Collet, Tinh-Hai

2015-01-01

. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES: The primary outcome was hip...... fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS: Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975...... hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS...

Self-reported Sleep Duration and Subclinical Atherosclerosis in a General Population of Japanese Men

Science.gov (United States)

Suzuki, Sentaro; Arima, Hisatomi; Miyazaki, Soichiro; Fujiyoshi, Akira; Kadota, Aya; Takashima, Naoyuki; Hisamatsu, Takashi; Kadowaki, Sayaka; Zaid, Maryam; Torii, Sayuki; Horie, Minoru; Murata, Kiyoshi; Miura, Katsuyuki; Ueshima, Hirotsugu

2018-01-01

Aim: There are few data regarding associations between sleep duration and subclinical atherosclerosis in Japan. The aim of this study was to evaluate associations of self-reported sleep duration with calcification in the coronary arteries (CAC) and carotid intima media thickness (IMT) in Japanese men. Methods: This was a cross-sectional survey of 1093 randomly selected men from Kusatsu City, Japan. Average sleep duration on weekdays was estimated through questionnaire; CAC by computed tomography; and carotid IMT by ultrasonography. Results: The prevalence of CAC was 50.0% for participants with sleep duration 0.1). Conclusion: Self-reported sleep duration was not associated with increased CAC or carotid IMT in a general population of Japanese men. PMID:28747590

Subclinical Thyroid Dysfunction and Depressive Symptoms among Elderly

DEFF Research Database (Denmark)

Blum, Manuel R; Wijsman, Liselotte W; Virgini, Vanessa S

2016-01-01

adults aged 70-82 years with pre-existing cardiovascular disease or known cardiovascular risk factors, TSH and free T4 levels were measured at baseline and repeated after 6 months to define persistent thyroid function status. Main outcome measures were depressive symptoms, assessed with the Geriatric...... on the association of persistent subclinical thyroid dysfunction and depression, subclinical hypothyroidism was not associated with increased depressive symptoms among older adults at high cardiovascular risk. Persistent subclinical hyperthyroidism might be associated with increased depressive symptoms, which......BACKGROUND: Subclinical hypothyroidism has been associated with depressive symptoms in cross-sectional studies, but prospective data and data on subclinical hyperthyroidism are scarce. METHODS: In the Leiden sub-study of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) among...

Is there an independent effect of polycystic ovary syndrome (PCOS and menopause on the prevalence of subclinical atherosclerosis in middle aged women?

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Evelyn O Talbott

2008-04-01

Full Text Available Evelyn O Talbott, Jeanne Zborowski, Judy Rager, Juley R StragandDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USAAbstract: Polycystic ovary syndrome (PCOS, a common reproductive endocrine condition manifests at puberty, and is characterized by hyperandrogenism, chronic anovulation, and obesity. PCOS cases exhibit an adverse coronary heart disease (CHD profile at an early age, including insulin resistance, dyslipidemia and increased central adiposity. It can be hypothesized that the menopausal transition, whether natural or surgical, may provide an additional “insult”, resulting in greater cumulative risk to their vasculature. Coronary artery calcification (CAC, a measure of subclinical atherosclerosis (SCA, was measured by electron beam tomography in 149 PCOS cases and 166 controls (mean age 47.3 and 49.4 respectively. Cases had a higher prevalence of CAC (63.1% compared to controls (41.0%, (p = 0.037 after adjustment for age and BMI. A total of 22 cases and 39 controls had undergone natural menopause, 12 cases and 26 controls underwent surgical menopause (with biochemical confirmation and 115 cases and 101 controls reported being currently premenopausal. There was a significant difference in CAC values between cases and controls in all three-menopause categories including pre-menopausal, surgically induced and natural menopause (p < 0.001. Duration since menopause (years and use of hormone replacement therapy were not different between cases and controls for the two menopause groups. Logistic regression was carried out with CAC (≤10 vs >10 as the dependent variable, and independent variables: PCOS status, current age, BMI, and menopausal status, (pre-menopause, surgical and natural menopause and selected CHD risk factors. The data indicate that women with PCOS exhibit significantly increased CAC compared to controls after adjustment for age and BMI and menopausal status. PCOS

P-wave dispersion in endogenous and exogenous subclinical hyperthyroidism.

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Gen, R; Akbay, E; Camsari, A; Ozcan, T

2010-02-01

The aim of this study was to measure maximum P wave duration (Pmax) and P wave dispersion (PWD), which can be indicators for the risk of paroxysmal atrial fibrillation when increased, and to reveal their relationship with thyroid hormone levels in patients with endogenous and exogenous subclinical hyperthyroidism. Seventy-one patients with sublinical thyrotoxicosis (34 endogenous, 37 exogenous) and 69 healthy individuals were enrolled in the study. Pmax and minimum P wave duration (Pmin) on electrocardiogram recordings were measured and PWD was calculated as Pmax-Pmin. Pmax (pendogenous subclinical hyperthyroidism compared with the control group. Pmax (pexogenous subclinical thyrotoxicosis compared with the control group. Pmax (p=0.710) and PWD (p=0.127) were not significantly different in patients with endogenous subclinical hyperthyroidism compared with exogenous subclinical hyperthyroid patients. Pmax and PWD negatively associated with TSH in endogenous and exogenous subclinical hyperthyroidism. In the present study, we observed that Pmax and PWD were longer in patients with endogenous and exogenous subclinical hyperthyroidism. Lack of a difference in Pmax and PWD between patients with endogenous and exogenous subclinical hyperthyroidism seems to support the idea that hormone levels rather than the etiology of thyrotoxicosis affect the heart.

Subclinical hypothyroidism

DEFF Research Database (Denmark)

Bak, Peter; Hjortshøj, Cristel S; Gaede, Peter

2018-01-01

OBJECTIVE: Cyanotic congenital heart disease is a systemic disease, with effects on multiple organ systems. A high prevalence of subclinical hypothyroidism (SCH) has been reported in a small cohort of cyanotic congenital heart disease patients. Subclinical hypothyroidism has been associated...... with various adverse cardiovascular effects, as well as an increased risk of progression to overt hypothyroidism. The aim of this study was to examine the prevalence of SCH in cyanotic congenital heart disease patients, consider possible etiologies, and evaluate thyroid function over time. METHODS: First, 90...... follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03...

The role of coronary microvascular dysfunction in the genesis of cardiovascular diseases

International Nuclear Information System (INIS)

Parodi, O.; Sambuceti, G.

1996-01-01

Using PET, myocardial perfusion abnormalities secondary to microvascular disorders have beeen investigated in arterial hypertension (AH), dilated and hypertrophic cardiomyopathy (CM), as well as in ischemic heart disease (CAD). In AH, regional perfusion at rest is within the normal range, while the coronary reserve and flow response to increase in metabolic demand are blunted. Both dilated and hypertrophic CM demonstrate abnormal vasodilaing capability, wich as bee schown to be presented in the subclinical form of dilated DM; the reduction of coronary reserve is not related to the presence and extent of the hemodynamic impairment in dilated CM, and involved also nonhypertropied myocardium in asymmetric hypertropic CM. These finding indicate a primary involvement of coronary microcirculation in non advanced forms of dilated and hypertrophic CM. Finally, in patients with CAD, myocardia teritories supplied by angiographically normal coronary arteries schow abnormal coronary reserve and flow during pacing, tachycardia, indicating that, even in absence of epicardial coronary artery obstruction, microcirculation is impaired in subject with coronary atherosclerosis. this abnormally can smooth perfusion differences, between control andd jeopardized regions. Although the agreement with the angiographic documantation of coronary artery disease has been frequently considered to characterize the diagnostic reliability of these techiques, the evaluation of myocardial perfusion provides an independent tool for the functional assessment of patient with heart disease. The possibility of obtain measurement of regional myocardial blood flow, provided by positron emission thermography, helps to identify the mechanisms affecting flow regulation in the myocardium. This tool thus provides a new rationale for the application of perfusion imaging, to obtain a more precise characterization of these patients, beyond the agreement with the morphological angiographic picture

Hyperthyroidism in patients with ischaemic heart disease after iodine load induced by coronary angiography: Long-term follow-up and influence of baseline thyroid functional status.

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Bonelli, Nadia; Rossetto, Ruth; Castagno, Davide; Anselmino, Matteo; Vignolo, Francesca; Parasiliti Caprino, Mirko; Gaita, Fiorenzo; Ghigo, Ezio; Garberoglio, Roberto; Grimaldi, Roberto; Maccario, Mauro

2018-02-01

To study the effect of a iodine load on thyroid function of patients with ischaemic heart disease (IHD) and the long-term influence of unknown subclinical hyperthyroidism. Subclinical hyperthyroidism is considered an independent risk factors for cardiovascular morbidity of patients with IHD. They routinely undergo coronary angiography with iodine contrast media (ICM) which may induce or even worsen hyperthyroidism. A cross-sectional study followed by a longitudinal study on patients with subclinical hyperthyroidism. 810 consecutive IHD outpatients without known thyroid diseases or treatment with drugs influencing thyroid activity undergoing elective coronary angiography. We evaluated thyroid function either before and 1 month after ICM; patients with thyrotoxicosis at baseline or after ICM were then followed up for 1 year. 58 patients had hyperthyroidism at baseline (HB, 7.2%), independently associated to FT4 levels, thyroid nodules and family history of thyroid diseases. After ICM, the prevalence of hyperthyroidism was 81 (10%). Hyperthyroidism after ICM was positively predicted by baseline fT4 levels, thyroid nodules, age over 60, male gender, family history of thyroid diseases. Three months after ICM, 34 patients (4.2%) still showed hyperthyroidism (22 from HB, 13 treated with methimazole). One year after ICM, hyperthyroidism was still present in 20 patients (2.5%, all from HB, 13 treated). The prevalence of spontaneous subclinical hyperthyroidism in IHD is surprisingly elevated and is further increased by iodine load, particularly in patients with thyroid nodules and familial history of thyroid diseases, persisting in a not negligible number of them even after one year. © 2017 John Wiley & Sons Ltd.

Subclinical pertussis in incompletely vaccinated and unvaccinated ...

African Journals Online (AJOL)

subclinical whooping cough) does in fact occur. Recent studies have shown subclinical disease in vaccinated infants ... through home visits by a community health nurse with ..... The current study extends the knowledge of contagious spread of ...

Subclinical abortions in patients treated with clomiphene citrate

International Nuclear Information System (INIS)

Ho, P.C.; Tang, G.W.

1982-01-01

Using radioimmunoassay for human chorionic gonadotrophin beta-subunit, 39 treatment cycles of clomiphene citrate therapy were studied prospectively for incidence of subclinical abortions. Eight treatment cycles resulted in clinically recognizable pregnancies and three other treatment cycles ended up with subclinical abortions. The plasma progesterone levels in patients with subclinical abortions at the 13th day after ovulation were lower than those in patients with normal pregnancies. (author)

Management of Subclinical Hyperthyroidism

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Santos Palacios, Silvia; Pascual-Corrales, Eider; Galofre, Juan Carlos

2012-01-01

The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient’s medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves’ disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation). PMID:23843809

Subclinical thyroid dysfunction and risk of carotid atherosclerosis.

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Hosu Kim

Full Text Available The effect of subclinical thyroid dysfunction on vascular atherosclerosis remains uncertain. The objective of this study was to elucidate the association between sustained subclinical thyroid dysfunction and carotid plaques, which are an early surrogate marker of systemic atherosclerosis.The study included 21,342 adults with consistent thyroid hormonal status on serial thyroid function tests (TFTs and carotid artery duplex ultrasonography at a health screening center between 2007 and 2014. The effect of subclinical thyroid dysfunction on baseline carotid plaques and newly developed carotid plaques during 5-year follow-up was determined by logistic regression analyses and GEE (Generalized Estimating Equations, respectively.Carotid plaques were more common in the subclinical hypothyroidism (55.6% than the euthyroidism (47.8% at baseline. However, in multivariable analysis, thyroid status was not a significant risk for the carotid plaques at baseline. Instead, traditional cardiovascular risk factors, such as age (P <0.001, systolic blood pressure (P = 0.023, fasting blood glucose (P = 0.030, and creatinine (P = 0.012 were associated with baseline carotid plaques in subclinical hypothyroidism. In longitudinal analyses of subjects who were followed up for more than 5 years, there was no significant difference in the cumulative incidence of new carotid plaques according to time between subjects with subclinical hypothyroidism and those with euthyroidism (P = 0.392.Sustained subclinical thyroid dysfunction did not affect the baseline or development of carotid plaques in healthy individuals.

Thyroid stimulating hormone and subclinical thyroid dysfunction

International Nuclear Information System (INIS)

Guo Yongtie

2008-01-01

Subclinical thyroid dysfunction has mild clinical symptoms. It is nonspecific and not so noticeable. It performs only for thyroid stimulating hormone rise and decline. The value of early diagnosis and treatment of thyroid stimulating hormone in subclinical thyroid dysfunction were reviewed. (authors)

Pulmonary functions in patients with subclinical hypothyroidism.

Science.gov (United States)

Cakmak, Gulfidan; Saler, Tayyibe; Saglam, Zuhal Aydan; Yenigun, Mustafa; Ataoglu, Esra; Demir, Tuncalp; Temiz, Levent Umit

2011-10-01

To determine whether alterations in pulmonary function takes place in subclinical hypothyroidism by examining the diffusion lung capacity and muscle strength of such patients. This is a descriptive study conducted in 2009 at Haseki Training and Research Hospital, Istanbul, Turkey. Hundred and twenty-six patients with subclinical hypothyroidism and 58 age and sex matched individuals were recruited. Simple spirometry tests were performed, and pulmonary diffusion capacity (DLco) and muscle strength were measured. ScH patients showed a significant reduciton of the following pulmonary function tests (% predicted value) as compared with control subjects: FVC, FEV1, FEV1%, FEF25-75, FEF25-75%, DLco, DLco/VA, Pimax, Pimax% and Pemax%. These data indicate that pulmonary functions are effected in subclinical hypothyrodism. Therefore patients with or who are at high risk of having subclinical hypothyroidism, should be subjected to evaluation of pulmonary functions with simple spirometry.

Subclinical Thyroid Dysfunction and Frailty Among Older Men

Science.gov (United States)

Virgini, Vanessa S.; Rodondi, Nicolas; Cawthon, Peggy M.; Harrison, Stephanie Litwack; Hoffman, Andrew R.; Orwoll, Eric S.; Ensrud, Kristine E.

2015-01-01

Context: Both subclinical thyroid dysfunction and frailty are common among older individuals, but data on the relationship between these 2 conditions are conflicting. Objective: The purpose of this study was to assess the cross-sectional and prospective associations between subclinical thyroid dysfunction and frailty and the 5 frailty subdomains (sarcopenia, weakness, slowness, exhaustion, and low activity). Setting and Design: The Osteoporotic Fractures in Men Study is a prospective cohort study. Participants: Men older than 65 years (n = 1455) were classified into 3 groups of thyroid status: subclinical hyperthyroidism (n = 26, 1.8%), subclinical hypothyroidism (n = 102, 7.0%), and euthyroidism (n = 1327, 91.2%). Main Outcome Measures: Frailty was defined using a slightly modified Cardiovascular Health Study Index: men with 3 or more criteria were considered frail, men with 1 to 2 criteria were considered intermediately frail, and men with no criteria were considered robust. We assessed the cross-sectional relationship between baseline thyroid function and the 3 categories of frailty status (robust/intermediate/frail) as well as the prospective association between baseline thyroid function and subsequent frailty status and mortality after a 5-year follow-up. Results: At baseline, compared with euthyroid participants, men with subclinical hyperthyroidism had an increased likelihood of greater frailty status (adjusted odds ratio, 2.48; 95% confidence interval, 1.15–5.34), particularly among men aged hyperthyroidism were not consistently associated with overall frailty status or frailty components. Conclusion: Among community-dwelling older men, subclinical hyperthyroidism, but not subclinical hypothyroidism, is associated with increased odds of prevalent but not incident frailty. PMID:26495751

Subclinical Cushing's syndrome: current concepts and trends.

Science.gov (United States)

Zografos, George N; Perysinakis, Iraklis; Vassilatou, Evangeline

2014-01-01

Clinically inapparent adrenal masses which are incidentally detected have become a common problem in everyday practice. Approximately 5-20% of adrenal incidentalomas present subclinical cortisol hypersecretion which is characterized by subtle alterations of the hypothalamic-pituitary-adrenal axis due to adrenal autonomy. This disorder has been described as subclinical Cushing's syndrome, since there is no typical clinical phenotype. The diagnosis of subclinical Cushing's syndrome is based on biochemical evaluation; however, there is still no consensus for the biochemical diagnostic criteria. An abnormal 1mg dexamethasone suppression test (DST) as initial screening test in combination with at least one other abnormal test of the hypothalamic-pituitary-adrenal axis has been advocated by most experts for the diagnosis of subclinical Cushing's syndrome. DST is the main method of establishing the diagnosis, while there is inhomogeneity of the information that other tests provide. Arterial hypertension, diabetes mellitus type 2 or impaired glucose tolerance, central obesity, osteoporosis/vertebral fractures and dyslipidemia are considered as detrimental effects of chronic subtle cortisol excess, although there is no proven causal relationship between subclinical cortisol hypersecretion and these morbidities. Therapeutic strategies include careful observation along with medical treatment of morbidities potentially related to subtle cortisol hypersecretion versus laparoscopic adrenalectomy. The optimal management of patients with subclinical Cushing's syndrome is not yet defined. The conservative approach is appropriate for the majority of these patients; however, the duration of follow-up and the frequency of periodical evaluation still remain open issues. Surgical resection may be beneficial for patients with hypertension, diabetes mellitus type 2 or abnormal glucose tolerance and obesity.

Subclinical form of the American visceral leishmaniasis

Directory of Open Access Journals (Sweden)

Mônica Elinor Alves Gama

2004-12-01

Full Text Available The subclinical form of visceral leishmaniasis (VL shows nonspecific clinical manifestations, with difficulties being frequently met in its clinical characterization and diagnostic confirmation. Thus, the objective of the present study was to define the clinical-laboratory profile of this clinical form. A cohort study was conducted in the state of Maranhão, Brazil, from January/1998 to December/2000, with monthly follow-up of 784 children aged 0-5 years. Based on the clinical-laboratory parameters reported in the literature, four categories were established, with the children being classified (according to their clinical-evolutive behavior as asymptomatic (N = 144, as having the subclinical form (N = 33 or the acute form (N = 12 or as subjects "without VL" (N = 595. Multiple discriminant analysis demonstrated that the combination of fever, hepatomegaly, hyperglobulinemia, and increased blood sedimentation rate (BSR can predict the subclinical form of VL as long as it is not associated with splenomegaly or leukopenia. Subjects with the subclinical form did not show prolonged or intermittent evolution or progression to the acute form of VL. Subclinical cases have a profile differing from the remaining clinical forms of VL, being best characterized by the combination of fever, hepatomegaly, hyperglobulinemia, and increased BSR.

Impact of bovine subclinical mastitis and effect of lactational treatment

NARCIS (Netherlands)

van den Borne, B.H.P.|info:eu-repo/dai/nl/304836826

2010-01-01

This thesis aimed to quantify the impact of subclinical mastitis in dairy cattle in the Netherlands and to explore the epidemiologic and economic effects of antimicrobial treatment of recently acquired subclinical mastitis during lactation. First, the occurrence of (sub)clinical mastitis was

Coffee Consumption and Coronary Artery Calcium Score: Cross-Sectional Results of ELSA-Brasil (Brazilian Longitudinal Study of Adult Health).

Science.gov (United States)

Miranda, Andreia M; Steluti, Josiane; Goulart, Alessandra C; Benseñor, Isabela M; Lotufo, Paulo A; Marchioni, Dirce M

2018-03-24

Available evidence for the relationship between coffee intake and subclinical atherosclerosis is limited and inconsistent. This study aimed to evaluate the association between coffee consumption and coronary artery calcium (CAC) in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). This cross-sectional study is based on baseline data from participants of the ELSA-Brasil cohort. Only participants living in São Paulo, Brazil, who underwent a CAC measurement (n=4426) were included. Coffee consumption was collected using a food frequency questionnaire. CAC was detected with computed tomography and expressed as Agatston units. CAC was further categorized as an Agatson score ≥100 (CAC ≥100). In multiple logistic regression analysis considering intake of coffee and smoking status interaction, significant inverse associations were observed between coffee consumption (>3 cups/d) and CAC≥100 (odds ratio [OR]: 0.85 [95% confidence interval, 0.58-1.24] for ≤1 cup/d; OR: 0.73 [95% confidence interval, 0.51-1.05] for 1-3 cups/d; OR: 0.33 [95% confidence interval, 0.17-0.65] for >3 cups/d). Moreover, there was a statistically significant interaction effect for coffee consumption and smoking status ( P =0.028 for interaction). After stratification by smoking status, the analysis revealed a lower OR of coronary calcification in never smokers drinking >3 cups/d (OR: 0.37 [95% confidence interval, 0.15-0.91]), whereas among current and former smokers, the intake of coffee was not significantly associated with coronary calcification. Habitual consumption of >3 cups/d of coffee decreased odds of subclinical atherosclerosis among never smokers. The consumption of coffee could exert a potential beneficial effect against coronary calcification, particularly in nonsmokers. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study.

Science.gov (United States)

Calderon-Margalit, Ronit; Siscovick, David; Merkin, Sharon S; Wang, Erica; Daviglus, Martha L; Schreiner, Pamela J; Sternfeld, Barbara; Williams, O Dale; Lewis, Cora E; Azziz, Ricardo; Schwartz, Stephen M; Wellons, Melissa F

2014-12-01

To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD. © 2014 American Heart Association, Inc.

Subclinical hyperthyroidism: clinical features and treatment options.

Science.gov (United States)

Biondi, Bernadette; Palmieri, Emiliano Antonio; Klain, Michele; Schlumberger, Martin; Filetti, Sebastiano; Lombardi, Gaetano

2005-01-01

Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.

Subclinical Hypothyroidism: A Prospective Observational Study from Southern India.

Science.gov (United States)

Sridhar, Mathrubootham; Mahadevan, Shriraam; Vishwanathan, Latha; Subbarayan, Anbezhil

2018-03-15

To assess the natural history and progression of subclinical hypothyroidism and to study factors which help predict evolution of subclinical hypothyroidism into overt hypothyroidism. Longitudinal study in 40 children (2-16 yrs) presenting with subclinical hypothyroidism in a tertiary care unit in Chennai, India. Patients showing evidence of overt hypothyroidism or thyroid stimulating hormone ≥15 mIU/mL during follow-up were started on thyroxine. Others were followed up with 3-monthly thyroid function tests up to one year. At the end of our study period 3 (7.5%) were overtly hypothyroid, 16 (40%) remained as subclinical hypothyroid, and 21 (52.5%) became euthyroid. Evidence of auto- immunity at baseline was a significant (Phypothyroidism. Subclinical hypothyroidism in children, with thyroid stimulating hormone upto 15 mIU/L and irrespective of thyroid autoimmunity, needs only periodic clinical and biochemical follow up. Thyroid autoimmunity may point to an increased probability of progression to overt hypothyroidism.

Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health).

Science.gov (United States)

Kianoush, Sina; Yakoob, Mohammad Yawar; Al-Rifai, Mahmoud; DeFilippis, Andrew P; Bittencourt, Marcio S; Duncan, Bruce B; Bensenor, Isabela M; Bhatnagar, Aruni; Lotufo, Paulo A; Blaha, Michael J

2017-06-24

There is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. We studied 14 103 participants without clinical cardiovascular disease in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross-sectional associations between smoking parameters and inflammation (high-sensitivity C-reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7±8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (β=0.24, 0.19-0.29 mg/L; P media thickness (β=0.03, 0.02-0.04 mm; P 0 (odds ratio: 1.83; 95% confidence interval, 1.46-2.30; P media thickness levels and odds of ankle-brachial index ≤1.0 and CAC >0 were lower with increasing time since quitting ( P 0 ( P =0.03) after adjusting for duration of smoking. Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

[Should subclinical hypothyroidism in older persons be treated?

NARCIS (Netherlands)

Elzen, W.P. den; Smit, J.W.A.; Mooijaart, S.P.; Gussekloo, J.

2012-01-01

Subclinical hypothyroidism is a common finding in older persons. Clinical guidelines are inconsistent in providing recommendations for the treatment of subclinical hypothyroidism, especially in older persons. To date, there is no high-quality evidence from randomized controlled trials about the

Sub-clinical hypothyroidism in infertile Nigerian women with ...

African Journals Online (AJOL)

Studies on the impact of subclinical hypothyroidism in infertility are scarce and this seeks to determine the proportion of infertile Nigerian women with hyperprolactinaemia that had subclinical hypothyroidism. Serum prolactin and thyroid stimulating hormone were determined using ELECSYS 1010 auto analyzer.

Subclinical thyroid disorders and cognitive performance among adolescents in the United States.

Science.gov (United States)

Wu, Tiejian; Flowers, Joanne W; Tudiver, Fred; Wilson, Jim L; Punyasavatsut, Natavut

2006-04-19

Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States. Study sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Serum thyroxine (T4) and thyroid stimulating hormone (TSH) were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments. Subclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level. Subclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.

Therapeutic Effect of Nisin Z on Subclinical Mastitis in Lactating Cows▿

OpenAIRE

Wu, Junqiang; Hu, Songhua; Cao, Liting

2007-01-01

Bovine subclinical mastitis is an inflammation of the mammary gland caused by bacterial intramammary infection, accounting for large economic losses. Treatment of subclinical mastitis is not suggested for lactating cows due to the risk of milk contamination. The objectives of this study were to evaluate an antimicrobial peptide, nisin, in the treatment of subclinical mastitis in lactating cows. A total of 90 lactating Holstein cows with subclinical mastitis were randomly divided into nisin-tr...

Subclinical hyperthyroidism: to treat or not to treat?

NARCIS (Netherlands)

Hoogendoorn, E.H.; Heijer, M. den; Dijk, A.P.J. van; Hermus, A.R.M.M.

2004-01-01

Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical

Unresolved Subclinical Hypothyroidism is Independently Associated with Progression of Chronic Kidney Disease

Science.gov (United States)

Kim, Eun Oh; Lee, Ihn Suk; Choi, Yoo A; Lee, Sang Ju; Chang, Yoon Kyung; Yoon, Hye Eun; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok

2014-01-01

Background and Aim: Patients with chronic kidney disease (CKD) often have subclinical hypothyroidism. However, few reports have investigated changes in the status of subclinical hypothyroidism in CKD patients and its clinical significance in CKD progression. Methods: We included 168 patients with nondialysis-dependent CKD stages 2-4. The normalization of subclinical hypothyroidism during follow-up was assessed, and the association between transitions in subclinical hypothyroid status and the rate of decline of the estimated glomerular filtration rate (eGFR) was investigated. Results: At baseline, 127 patients were euthyroid and 41 (24.4%) patients were diagnosed with subclinical hypothyroidism. Of these 41 patients, 21 (51.2%) spontaneously resolved to euthyroid during follow-up. The rate of eGFR decline of patients with resolved subclinical hypothyroidism was similar to that of euthyroid patients. The patients with unresolved subclinical hypothyroidism showed a steeper renal function decline than patients with euthyroidism or resolved subclinical hypothyroidism (all p hypothyroidism than in those who were euthyroid (p = 0.006). In multivariate linear regression for rate of eGFR decrease, unresolved subclinical hypothyroidism (β = -5.77, p = 0.001), baseline renal function (β = -0.12, p hypothyroidism did not resolve to euthyroidism, and this lack of resolution was independently associated with rapid renal function decline. PMID:24396286

Subclinical Hypercorticism: the Necessity of Diagnostic Search

Directory of Open Access Journals (Sweden)

А.N. Kvacheniuk

2016-02-01

Full Text Available Considering certain difficulties in subclinical hypercorticism diagnosis, the object of this work is to focus attention of doctors in different areas on the necessity of thorough examination of patients with pathological conditions that may be the manifestation of Cushing’s syndrome (arterial hypertension, obesity, impaired carbohydrate metabolism and osteoporosis. The laboratory diagnosis is the instrument for early subclinical hypercorticism detection.

Subclinical thyroid disorders and cognitive performance among adolescents in the United States

Directory of Open Access Journals (Sweden)

Wilson Jim L

2006-04-01

Full Text Available Abstract Background Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States. Methods Study sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III. Serum thyroxine (T4 and thyroid stimulating hormone (TSH were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R and the Wechsler Intelligence Scale for Children-Revised (WISC-R. The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments. Results Subclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level. Conclusion Subclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.

Subclinical hypothyroidism in childhood - current knowledge and open issues.

Science.gov (United States)

Salerno, Mariacarolina; Capalbo, Donatella; Cerbone, Manuela; De Luca, Filippo

2016-12-01

Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T 4 or free T 4 . This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.

Spontaneous Bacterial Peritonitis in Subclinical Hypothyroidism

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Dalip Gupta

2013-11-01

Full Text Available Hypothyroidism is an uncommon cause of ascites. Here we describe a case of a 75 year-old female patient with spontaneous bacterial peritonitis and subclinical hypothyroidism that resolved with thyroid replacement and antibiotic therapy respectively. Ascitic fluid analysis revealed a gram-positive bacterium on gram staining. A review of the literature revealed just one other reported case of myxoedema ascites with concomitant spontaneous bacterial peritonitis and no case has till been reported of spontaneous bacterial peritonitis in subclinical hypothyroidism.

Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging.

Science.gov (United States)

Bybee, Kevin A; Lee, John; Markiewicz, Richard; Longmore, Ryan; McGhie, A Iain; O'Keefe, James H; Hsu, Bai-Ling; Kennedy, Kevin; Thompson, Randall C; Bateman, Timothy M

2010-04-01

A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS). Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was > or =100, > or =400, and > or =1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC. Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.

Analysis of Subclinical Hyperthyroidism Influence on Parameters of Bone Metabolism

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I.V. Pankiv

2016-03-01

Full Text Available State of subclinical hypothyroidism can be considered as the optimal model for assessing the significance of thyroid stimulating hormone (TSH for bone tissue in clinical practice. Objective: to make a comparative analysis of the impact of subclinical hyperthyroidism of various origins on the performance of bone mineral density (BMD and bone metabolism parameters. Materials and methods. The study in an outpatient setting included 112 women with a diagnosis of subclinical hyperthyroidism and duration of menopause for at least 5 years. Among the examinees, endogenous subclinical hyperthyroidism has been detected in 78 women (group I, exogenous subclinical hyperthyroidism on the background of suppressive levothyroxine therapy (group II — in 34. The control group (group III included 20 women without thyroid dysfunction. Results. The study first conducted a comparative analysis of bone metabolism, BMD indicators, as well as parameters of phosphorus and calcium, blood lipids in women with subclinical hyperthyroidism of various origins. A positive correlation between markers of bone metabolism and free triiodothyronine (fT3 as hormones necessary for the development of the skeleton and to maintain its homeostasis indicates a physiological effect of parathyroid hormone and fT3 on bone tissue. It is shown that the bone metabolism and BMD depend not only on the content of TSH, but also on the causes of subclinical hyperthyroidism.Conclusions. In postmenopausal women with endogenous subclinical hyperthyroidism, there is a significant decline in BMD indices, more pronounced in the bones with the cortical structure. A negative correlation between markers of bone metabolism and TSH has been observed among all patients included in the study.

Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

Science.gov (United States)

Donnay, S; Balsa, J A; Álvarez, Julia; Crespo, C; Pérez-Alcántara, F; Polanco, C

2013-11-01

Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Pregnancy aggravates proteinuria in subclinical glomerulonephritis in the rat

NARCIS (Netherlands)

Faas, MM; Bakker, WW; Poelman, RT; Schuiling, GA

Because subclinical renal disease may be aggravated during pregnancy-as reflected in the occurrence of proteinuria, for example-we investigated whether a subclinical glomerulonephritis (SG) in the non-pregnant rat (passive Heymann nephritis), a condition without proteinuria, is aggravated when the

The inter-arm difference in systolic blood pressure is a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes.

Science.gov (United States)

Tanaka, Yoshimitsu; Fukui, Michiaki; Tanaka, Muhei; Fukuda, Yukiko; Mitsuhashi, Kazuteru; Okada, Hiroshi; Yamazaki, Masahiro; Hasegawa, Goji; Yoshioka, Keiji; Nakamura, Naoto

2014-06-01

Recent studies have suggested that the inter-arm blood pressure difference (IAD) is associated with cardiovascular events and mortality. The aim of this study was to assess whether the IAD could be a marker for subclinical atherosclerosis in patients with type 2 diabetes who are at high risk of cardiovascular disease (CVD). In a cross-sectional retrospective study of 206 Japanese patients with type 2 diabetes aged 49-76 years, we examined the correlation of the IAD with the carotid intima-media thickness (IMT), ankle-brachial index (ABI) or cardio ankle vascular index (CAVI). The IAD was positively correlated with the maximum IMT (r=0.266, P<0.0001), mean IMT (r=0.209, P=0.00726) or CAVI (r=0.240, P=0.0005). The IAD was higher in patients with CVD than in those without (P=0.0020). A multiple linear regression analysis demonstrated that the IAD was an independent determinant of maximum IMT (β=0.169, P=0.0167), mean IMT (β=0.178, P=0.0153), ABI (β=-0.222, P=0.0033) or CAVI (β=0.213, P=0.0011) after adjusting for known risk factors. The area under the receiver operating characteristic curve (AUC) of the IAD as a predictor of subclinical atherosclerosis was similar to the AUC of the Framingham 10-year coronary heart disease risk score. In conclusion, the IAD could be a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes.

Relationships between serum MCP-1 and subclinical kidney disease: African American-Diabetes Heart Study

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Murea Mariana

2012-11-01

Full Text Available Abstract Background Monocyte chemoattractant protein-1 (MCP-1 plays important roles in kidney disease susceptibility and atherogenesis in experimental models. Relationships between serum MCP-1 concentration and early nephropathy and subclinical cardiovascular disease (CVD were assessed in African Americans (AAs with type 2 diabetes (T2D. Methods Serum MCP-1 concentration, urine albumin:creatinine ratio (ACR, estimated glomerular filtration rate (eGFR, and atherosclerotic calcified plaque (CP in the coronary and carotid arteries and infrarenal aorta were measured in 479 unrelated AAs with T2D. Generalized linear models were fitted to test for associations between MCP-1 and urine ACR, eGFR, and CP. Results Participants were 57% female, with mean ± SD (median age 55.6±9.5 (55.0 years, diabetes duration 10.3±8.2 (8.0 years, urine ACR 149.7±566.7 (14.0 mg/g, CKD-EPI eGFR 92.4±23.3 (92.0 ml/min/1.73m2, MCP-1 262.9±239.1 (224.4 pg/ml, coronary artery CP 280.1±633.8 (13.5, carotid artery CP 47.1±132.9 (0, and aorta CP 1616.0±2864.0 (319.0. Adjusting for age, sex, smoking, HbA1c, BMI, and LDL, serum MCP-1 was positively associated with albuminuria (parameter estimate 0.0021, P=0.04 and negatively associated with eGFR (parameter estimate −0.0003, P=0.001. MCP-1 remained associated with eGFR after adjustment for urine ACR. MCP-1 levels did not correlate with the extent of CP in any vascular bed, HbA1c or diabetes duration, but were positively associated with BMI. No interaction between BMI and MCP-1 was detected on nephropathy outcomes. Conclusions Serum MCP-1 levels are associated with eGFR and albuminuria in AAs with T2D. MCP-1 was not associated with subclinical CVD in this population. Inflammation appears to play important roles in development and/or progression of kidney disease in AAs.

pattern of subclinical thyroid disease

International Nuclear Information System (INIS)

Ijaz, A.; Marri, M.H.; Qureshi, A.H.; Qamar, M.A.; Ali, N.

2002-01-01

Objective: To evaluate the prevalence of subclinical thyroid disease (SCTD) in local population visiting a hospital laboratory for thyroid function tests. Design: It was a hospital - based study carried in consecutive patients who reported for thyroid function tests in the hospital laboratory. Place and duration of study: The study was conducted in combined military Hospital, Quetta during June 1999 to September 2000. Subject and methods: Serum samples of 917 patients living in Quetta and its surrounding were analysed for thyroid stimulating hormone (TSH) free thyroxin (FT4), and total tri-iodothyronine (T3) concentration using chemiluminescence technique on hormone auto analyser (LIA-Mat - Sangtech Germany). Results: Out of 917 patients, 287 (23%) were found to be having SCTD while overt thyroid disease was found in 288 (31%) patients. Prevalence of sub-clinical hypothyroidism (SCO) and sub-clinical hyperthyroidism (sce) was found to be almost equal with a profound female preponderance in both the groups. SCO was more common in children (<12 years of age). Conclusion: Almost every fourth patient reporting for thyroid function tests was diagnosed as having SCTD - a disease entity that is still not well known and that poses diagnostic and management problems for the pathologists and clinicians. (author)

Treatment of subclinical hyperthyroidism

DEFF Research Database (Denmark)

Mark, Peter D; Andreassen, Mikkel; Petersen, Claus L

2015-01-01

PURPOSE: The aim of this study was to investigate structure and function of the heart in subclinical hyperthyroidism (SH) before and after obtaining euthyroidism by radioactive iodine treatment, using high precision and observer-independent magnetic resonance imaging (MRI) technology. METHODS...

Subclinical Hypothyroidism in Children and Adolescents: Is It Clinically Relevant?

Directory of Open Access Journals (Sweden)

Aneta Gawlik

2015-01-01

Full Text Available Although subclinical hypothyroidism (SH is a common clinical problem, its diagnosis tends to be incidental. According to the definition, it should be asymptomatic, only detectable by screening. The presence or coincidence of any symptoms leads to L-thyroxine treatment. The clinical presentation, especially in younger patients with subclinical hypothyroidism, is still under dispute. Accordingly, the aim of this paper was to review the literature from the past seven years. The literature search identified 1,594 potentially relevant articles, of which 24 met the inclusion criteria. Few studies focus on the symptomatology of subclinical hypothyroidism, and most of them analyzed a small number of subjects. A significant correlation was found by some authors between subclinical hypothyroidism and a higher risk of hypertension, dyslipidemia, and migraine. No evidence of the impact of subclinical hypothyroidism on weight, growth velocity, and puberty was revealed. As the quality of most studies is poor and no definite conclusions can be drawn, randomized, large-scale studies in children and adolescents are warranted to determine the best care for patients with SH.

Subclinical Hyperthyroidism: When to Consider Treatment.

Science.gov (United States)

Donangelo, Ines; Suh, Se Young

2017-06-01

Subclinical hyperthyroidism is defined by a low or undetectable serum thyroid-stimulating hormone level, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (e.g., in Graves disease, toxic nodular goiter, or transient thyroiditis), by administration of thyroid hormone to treat malignant thyroid disease, or by unintentional excessive replacement therapy. The prevalence of subclinical hyperthyroidism in the general population is about 1% to 2%; however, it may be higher in iodinedeficient areas. The rate of progression to overt hyperthyroidism is higher in persons with thyroid-stimulating hormone levels less than 0.1 mIU per L than in persons with low but detectable thyroid-stimulating hormone levels. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation and heart failure in older adults, increased cardiovascular and all-cause mortality, and decreased bone mineral density and increased bone fracture risk in postmenopausal women. However, the effectiveness of treatment in preventing these conditions is unclear. A possible association between subclinical hyperthyroidism and quality-of-life parameters and cognition is controversial. The U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for thyroid dysfunction in asymptomatic persons. The American Thyroid Association and the American Association of Clinical Endocrinologists recommend treating patients with thyroid-stimulating hormone levels less than 0.1 mIU per L if they are older than 65 years or have comorbidities such as heart disease or osteoporosis.

The association between dietary cholesterol intake and subclinical atherosclerosis in Korean adults: The Kangbuk Samsung Health Study.

Science.gov (United States)

Rhee, Eun-Jung; Ryu, Seungho; Lee, Jong-Young; Lee, Sung Ho; Cheong, EunSun; Park, Se Eun; Park, Cheol-Young; Won, Yu Sam; Kim, Joon Mo; Cho, Dong-Sik; Chung, Hye-Kyung; Sung, Ki Chul

The Scientific Report of the Dietary Guidelines Advisory Committee (2015) concluded that restriction of dietary cholesterol is unnecessary in most adults for the prevention of cardiovascular disease. We aimed to assess the risk for subclinical atherosclerosis according to coronary artery calcium score (CACS), based on dietary cholesterol intake in apparently healthy Korean adults. This was a cross-sectional study performed in 30,068 participants (mean age 40.8 years; 84.5% men) in a health screening program in Korea. The data were collected from 2001 to 2013 and analyzed in 2015. Total energy intake and dietary cholesterol intake were assessed with a food frequency questionnaire. The participants were stratified according to quartile of dietary cholesterol intake. CACS was measured by multi-detector computed tomography. Lipid profiles were measured, and the participants were divided into 6 groups according to low-density lipoprotein cholesterol (LDL-C) level: 0. Dietary cholesterol intake did not correlate with mean value of serum LDL-C level. For both genders, the odds ratio for coronary artery calcification was not significantly greater with greater amounts of dietary cholesterol (as assessed by quartile). The risk for coronary artery calcification was not higher in subjects with LDL-C 70-129 mg/dL compared with those with LDL-C < 70 mg/dL; however, the risk was significantly greater in subjects with LDL-C ≥ 130 mg/dL compared with those with LDL-C < 70 mg/dL. Dietary cholesterol intake did not have an association with LDL-C level or with risk for coronary artery calcification in apparently healthy Korean adults. The results have to be translated with consideration of limitation of population-based studies. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Subclinical hyperthyroidism: current concepts and scintigraphic imaging.

Science.gov (United States)

Intenzo, Charles; Jabbour, Serge; Miller, Jeffrey L; Ahmed, Intekhab; Furlong, Kevin; Kushen, Medina; Kim, Sung M; Capuzzi, David M

2011-09-01

Subclinical hyperthyroidism is defined as normal serum free thyroxine and a free triiodothyronine level, with a thyroid-stimulating hormone level suppressed below the normal range and is usually undetectable. Although patients with this diagnosis have no or few signs and symptoms of overt thyrotoxicosis, there is sufficient evidence that it is associated with a relatively higher risk of supraventricular arrhythmias as well as the acceleration or the development of osteoporosis. Consequently, the approach to the patient with subclinical hyperthyroidism is controversial, that is, therapeutic intervention versus watchful waiting. Regardless, it is imperative for the referring physician to identify the causative thyroid disorder. This is optimally accomplished by a functional study, namely scintigraphy. Recognition of the scan findings of the various causes of subclinical hyperthyroidism enables the imaging specialist to help in diagnosing the underlying condition causing thyroid-stimulating hormone suppression thereby facilitating the workup and management of this thyroid disorder.

Subclinical bulimia predicts conduct disorder in middle adolescent girls.

Science.gov (United States)

Viinamäki, Anni; Marttunen, Mauri; Fröjd, Sari; Ruuska, Jaana; Kaltiala-Heino, Riittakerttu

2013-01-01

This study investigates the comorbidity and longitudinal associations between self-reported conduct disorder and subclinical bulimia in a community-based sample of Finnish adolescents in a 2-year prospective follow-up study. There are 2070 adolescents who participated in the survey as ninth graders (mean age 15.5) and followed-up 2 years later. The Youth Self-Report Externalizing scale was used to measure conduct disorder and DSM-IV-based questionnaire to measure bulimia. Co-occurrence of female conduct disorder and subclinical bulimia was found at ages 15 and 17. Subclinical bulimia among girls at age 15 was a risk factor for conduct disorder at age 17, but conduct disorder at age 15 was not predictive of subclinical bulimia at age 17. The pathway from bulimia to conduct disorder may be suggestive of an association with future borderline personality disorder among girls. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

BENEFICIAL EFFECTS OF LEVOTHYROXINE IN THE TREATMENT OF SUBCLINICAL HYPOTHYROIDISM

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Mulic Mersudin

2016-12-01

Full Text Available Introduction:Increased cardiovascular risk in thyroid dysfunction is associated with disorders of lipid and lipoproteins, endothelial dysfunction, metabolic, hormonal, hemodynamic changes and coagulation disorders. Subclinical hypothyroidism is characterized by a suprarnormal level of TSH with normal levels of thyroid hormones. The correlation between subclinical hypothyroidism of the lipid profile and cardiovascular outcomes remains unclear. Several intervention studies assessed the effect of levothyroxine therapy on the lipid profile of patients with subclinical hypothyroidism and obtained conflicting results. The aim of the research is to determine whether subclinical hypothyroidism is associated with the atherogenic lipid profile and whether these changes are reversible after the introduction of the L-thyroxine replacement therapy. Method: The study included 51 patients over 50 years of age with subclinical hypothyroidism. All the participants were subjected to an examination programme which included a detailed anamnesis and physical examination, laboratory tests (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, T3, T4, TSH. After eight weeks of levothyroxine therapy, the same laboratory parameters were determined in the patients. Results: Subjects with subclinical hypothyroidism had high average values: TSH (12.77 + 2.78 mIU / ml, total cholesterol (7.55 ± 0.79 mmol / l, LDL cholesterol (5.03 ± 0.61 mmol / l, triglycerides (2.48 ± 1.01 mmol / l; and the average value of HDL cholesterol was within reference values (1.12 ± 0.21 mmol / l. After eight weeks of levothyroxine replacement therapy, there was a statistically significant reduction of average values (p <0.0001: TSH (3.83 ± 1.33 mIU / ml, total cholesterol (6.28 ± 0.96 mmol / l, LDL cholesterol ( 4.03 ± 0.70 mmol / mmol / l l, triglycerides (1.98 ± 0.87 mmol / l; and the average value of HDL cholesterol increased significantly (p <0.0001 (1.32 ± 0.22 mmol

Prevalence, Impact, and Predictive Value of Detecting Subclinical Coronary and Carotid Atherosclerosis in Asymptomatic Adults

DEFF Research Database (Denmark)

Baber, Usman; Mehran, Roxana; Sartori, Samantha

2015-01-01

BACKGROUND: Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds...

Subclinical hyperthyroidism: to treat or not to treat?

OpenAIRE

Hoogendoorn, E; den Heijer, M; van Dijk, A P J; Hermus, A

2004-01-01

Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical hyperthyroidism, for example, effects on heart and bone mass, are discussed. Guidelines for treatment are given, based on expert opinion.

Subclinical Thyroid Dysfunction and the Risk for Fractures

Science.gov (United States)

Wirth, Christina D.; Blum, Manuel R.; da Costa, Bruno R.; Baumgartner, Christine; Collet, Tinh-Hai; Medici, Marco; Peeters, Robin P.; Aujesky, Drahomir; Bauer, Douglas C.; Rodondi, Nicolas

2015-01-01

Background Data on the association between subclinical thyroid dysfunction and fractures conflict. Purpose To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. Data Sources Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. Study Selection Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. Data Extraction One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. Data Synthesis The 7 population-based cohorts of heterogeneous quality included 50 245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2 = 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). Limitations Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. Conclusion Subclinical hyperthyroidism might be associated with

Effects of maternal subclinical hypothyroidism on amniotic fluid cells oxidative status.

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Novakovic, Tanja R; Dolicanin, Zana C; Djordjevic, Natasa Z

2018-06-01

In this study, we researched the effects of maternal subclinical hypothyroidism on the amniotic fluid cells oxidative metabolism during the first trimester of pregnancy. Oxidative stress and damage biomarkers were assayed in the amniotic fluid cells of healthy and pregnant women with subclinical hypothyroidism. Obtained results show that amniotic fluid cells of pregnant women with subclinical hypothyroidism have significantly higher concentrations of oxidative stress biomarkers (superoxide anion, nitric oxide, peroxynitrite) and oxidative damage (lipid peroxide and micronuclei frequency), but lower concentrations of hydrogen peroxide and oxidized glutathione in comparison to healthy pregnant women. We also showed that oxidative stress biomarkers were positively correlated with micronuclei frequency and lipid peroxide concentration in amniotic fluid cells of pregnant women with subclinical hypothyroidism. The present study provides the first evidence for prooxidative effects of maternal subclinical hypothyroidism on the fetus obtained by the estimating oxidative metabolism in the amniotic fluid cells. Copyright © 2018 Elsevier Inc. All rights reserved.

Subclinical depression in Urban Indian adolescents: Prevalence, felt needs, and correlates

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Singhal, Meghna; Manjula, M.; Vijay Sagar, K. John

2016-01-01

Background: Subclinical depression in adolescents constitutes a risk factor for future clinical depression and hence warrants examination. However, there is a paucity of research that documents subclinical depression among adolescents in India. Objectives: (a) To investigate the prevalence of subclinical depression in urban school-going adolescents; (b) to investigate the problems and felt needs of these adolescents; (c) to examine depression-related variables; and (d) to examine the relation...

How Does Subclinical Hyperthyroidism Affect Right Heart Function and Mechanics?

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Tadic, Marijana; Celic, Vera; Cuspidi, Cesare; Ilic, Sanja; Zivanovic, Vladimir; Marjanovic, Tamara

2016-02-01

Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals. We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations. Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Two-dimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV end-diastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level. Right ventricular and RA function as evaluated by 3DE and speckle-tracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population. © 2016 by the American Institute of Ultrasound in Medicine.

Hippocampal multimodal structural changes and subclinical depression in healthy individuals.

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Spalletta, Gianfranco; Piras, Fabrizio; Caltagirone, Carlo; Fagioli, Sabrina

2014-01-01

Several neuroimaging studies report reduced hippocampal volume in depressed patients. However, it is still unclear if hippocampal changes in healthy individuals can be considered a risk factor for progression to clinical depression. Here, we investigated subclinical depression and its hippocampal correlates in a non-clinical sample of healthy individuals, with particular regard to gender differences. One-hundred-two participants underwent a comprehensive clinical assessment, a high-resolution T1-weighted magnetic resonance imaging and diffusion tensor imaging protocol using a 3T MRI scanner. Data of macro-(volume) and micro-(mean diffusivity, MD) structural changes of the hippocampus were analyzed with reference to the Beck Depression Inventory score. Results of multivariate regression analyses revealed reduced bilateral volume, along with increased bilateral MD in hippocampal formation predicting subclinical depressive phenomenology only in healthy males. Conversely, subclinical depressive phenomenology in healthy female was accounted for by only lower educational level, in the absence of any hippocampal structure variations. To date, this is the only evidence reporting a relationship between subclinical depressive phenomenology and changes in hippocampal formation in healthy individuals. Our findings demonstrated that reduced volume, along with increased MD in hippocampal formation, is significantly associated with subclinical depressive phenomenology in healthy males. This encourages to study the hypothesis that early macro- and microstructural changes in hippocampi associated with subclinical depression may constitute a risk factor of developing depressive disorders in males. © 2013 Elsevier B.V. All rights reserved.

A case report of suicidal behavior related to subclinical hyperthyroidism

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Joo SH

2014-04-01

Full Text Available Soo-Hyun Joo, Jong-Hyun Jeong, Seung-Chul HongDepartment of Psychiatry, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, KoreaAbstract: Abnormalities in thyroid function are associated with many psychiatric symptoms. We present a report of a 15-year-old girl who was admitted to the psychiatry inpatient unit with symptoms of suicidal behavior, irritability, and impulsivity. One year previously, she had become more short-tempered, and had started to cut her wrists impulsively. Laboratory tests revealed subclinical hyperthyroidism. She was treated with anxiolytic and antithyroid drugs, and her suicidal ideation and irritability resolved. This case demonstrates that subclinical hyperthyroidism can be associated with suicidal behavior as well as overt hyperthyroidism. Early intervention is required to prevent suicidal behavior in patients with subclinical hyperthyroidism.Keywords: suicidal behavior, subclinical hyperthyroidism, anxiolytics

Test-day records as a tool for subclinical ketosis detection

OpenAIRE

Gantner Vesna; Potočnik K.; Jovanovac Sonja

2009-01-01

The prevalence, as well as the effect of subclinical ketosis on daily milk yield, was observed using 1.299,630 test-day records collected from January 2000 to December 2005 on 73,255 Slovenian Holstein cows. Subclinical ketosis was indicated by the fat to protein ratio (F/P ratio) higher than 1.5 in cows that yielded between 33 to 50 kg of milk per day (Eicher, 2004). The ketosis index was defined in relation to the timing of subclinical ketosis detection to the subsequent measures of test-da...

Ten-year trends in coronary calcification in individuals without clinical cardiovascular disease in the multi-ethnic study of atherosclerosis.

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Diane E Bild

Full Text Available Coronary heart disease (CHD incidence has declined significantly in the US, as have levels of major coronary risk factors, including LDL-cholesterol, hypertension and smoking, but whether trends in subclinical atherosclerosis mirror these trends is not known.To describe recent secular trends in subclinical atherosclerosis as measured by serial evaluations of coronary artery calcification (CAC prevalence in a population over 10 years, we measured CAC using computed tomography (CT and CHD risk factors in five serial cross-sectional samples of men and women from four race/ethnic groups, aged 55-84 and without clinical cardiovascular disease, who were members of Multi-Ethnic Study of Atherosclerosis (MESA cohort from 2000 to 2012. Sample sizes ranged from 1062 to 4837. After adjusting for age, gender, and CT scanner, the prevalence of CAC increased across exams among African Americans, whose prevalence of CAC was 52.4% in 2000-02, 50.4% in 2003-04, 60.0% is 2005-06, 57.4% in 2007-08, and 61.3% in 2010-12 (p for trend <0.001. The trend was strongest among African Americans aged 55-64 [prevalence ratio for 2010-12 vs. 2000-02, 1.59 (95% confidence interval 1.06, 2.39; p = 0.005 for trend across exams]. There were no consistent trends in any other ethnic group. Risk factors generally improved in the cohort, and adjustment for risk factors did not change trends in CAC prevalence.There was a significant secular trend towards increased prevalence of CAC over 10 years among African Americans and no change in three other ethnic groups. Trends did not reflect concurrent general improvement in risk factors. The trend towards a higher prevalence of CAC in African Americans suggests that CHD risk in this population is not improving relative to other groups.

The relationship of socioeconomic status with coronary artery calcification and pericardial fat.

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Nafakhi, Hussein; Almosawi, Abdulameer; Alnafakh, Hasan; Mousa, Widad

2017-01-01

Little data currently exist supporting the correlation of socioeconomic status (SES) to markers of subclinical coronary atherosclerosis. The main aim was to investigate the relationship of SES measured by economic status and educational level with coronary artery calcification (CAC) and pericardial fat volume (PFV) assessed by multi-detector computed tomography (MDCT). A total of 220 consecutive patients with suspected coronary artery disease, who underwent 64-slice MDCT angiography for assessment of coronary atherosclerosis, were recruited between January 2014 and March 2015. Of these, 186 patients were enrolled in this cross sectional study. Low economic status patients showed higher PFV values; median (inter-quartile range [IQR] was 94 [50-140] cm3, p = 0.00001 and r = 0.37, compared to patients with high economic status, and this association persisted even after multiple logistic regression to conventional cardiac risk factors (p = 0.004, CI 7.3-30.4), while patients with low economic status reported a higher calcium score (but statistically non significant) (p = 0.12) compared to high economic status patients. Pa-tients with no formal education showed higher PFV (median [IQR] was 93 [48-140] cm3, p = 0.01) compared to patients with bachelor's degree (median [IQR] was 56 [28-92] cm3), but this association was attenuated after further adjustment for conventional cardiac risk factors (p = 0.1, CI -9.52-10.88), while CAC showed no significant correlation with educational level (p = 0.2, r = 0.117). Socioeconomic status, particularly economic status measure, reported a significant inverse relationship with PFV independent of conventional cardiac risk factors.

Subclinical hypothyroidism and diabetic nephropathy in Iranian patients with type 2 diabetes.

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Mansournia, N; Riyahi, S; Tofangchiha, S; Mansournia, M A; Riahi, M; Heidari, Z; Hazrati, E

2017-03-01

Association of subclinical hypothyroidism with type 2 diabetes and its complications has been previously documented. These reports were, however, inconclusive and mainly gathered from Chinese and East Asian populations. In this study, we aimed to determine the prevalence of subclinical hypothyroidism and its relationship with diabetic nephropathy in Iranian individuals with type 2 diabetes, drawn from a white Middle Eastern population with an increasing prevalence of diabetes. In this cross-sectional study, 255 Iranian participants with type 2 diabetes and without history of thyroid disorders were included. Patients with TSH > 4.2 mIU/L and normal T4 were classified as having subclinical hypothyroidism. Diabetic nephropathy was diagnosed based on abnormal 24-h urinary albumin or protein measurements (24-h urinary albumin ≥30 mg/day or 24-h urinary protein ≥150 mg/day). Multivariate logistic regression was employed to obtain the OR for the relationship between subclinical hypothyroidism and diabetic nephropathy. We found that subclinical hypothyroidism and diabetic nephropathy were as prevalent as 18.1 and 41.2 %, respectively, among the participants. We also found that subclinical hypothyroidism was independently associated with higher rates of diabetic nephropathy, after multivariable adjustment (OR [95 % CI] 3.23 [1.42-7.37], p = 0.005). We found that the prevalence of subclinical hypothyroidism in Iranian diabetic population was among the highest rates reported to date. Our data supported the independent association of subclinical hypothyroidism with diabetic nephropathy, calling for further investigations to evaluate their longitudinal associations.

Walking speed and subclinical atherosclerosis in healthy older adults: the Whitehall II study.

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Hamer, Mark; Kivimaki, Mika; Lahiri, Avijit; Yerramasu, Ajay; Deanfield, John E; Marmot, Michael G; Steptoe, Andrew

2010-03-01

Extended walking speed is a predictor of incident cardiovascular disease (CVD) in older individuals, but the ability of an objective short-distance walking speed test to stratify the severity of preclinical conditions remains unclear. This study examined whether performance in an 8-ft walking speed test is associated with metabolic risk factors and subclinical atherosclerosis. Cross-sectional. Setting Epidemiological cohort. 530 adults (aged 63 + or - 6 years, 50.3% male) from the Whitehall II cohort study with no known history or objective signs of CVD. Electron beam computed tomography and ultrasound was used to assess the presence and extent of coronary artery calcification (CAC) and carotid intima-media thickness (IMT), respectively. High levels of CAC (Agatston score >100) were detected in 24% of the sample; the mean IMT was 0.75 mm (SD 0.15). Participants with no detectable CAC completed the walking course 0.16 s (95% CI 0.04 to 0.28) faster than those with CAC > or = 400. Objectively assessed, but not self-reported, faster walking speed was associated with a lower risk of high CAC (odds ratio 0.62, 95% CI 0.40 to 0.96) and lower IMT (beta=-0.04, 95% CI -0.01 to -0.07 mm) in comparison with the slowest walkers (bottom third), after adjusting for conventional risk factors. Faster walking speed was also associated with lower adiposity, C-reactive protein and low-density lipoprotein cholesterol. Short-distance walking speed is associated with metabolic risk and subclinical atherosclerosis in older adults without overt CVD. These data suggest that a non-aerobically challenging walking test reflects the presence of underlying vascular disease.

[Relationship between subclinical psychotic symptoms and cognitive performance in the general population].

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Martín-Santiago, Oscar; Suazo, Vanessa; Rodríguez-Lorenzana, Alberto; Ruiz de Azúa, Sonia; Valcárcel, César; Díez, Álvaro; Grau, Adriana; Domínguez, Cristina; Gallardo, Ricardo; Molina, Vicente

2016-01-01

Subclinical psychotic symptoms are associated to negative life outcomes in the general population, but their relationship with cognitive performance is still not well understood. Assessing the relationship between performance in cognitive domains and subclinical psychotic symptoms in the general population may also help understand the handicap attributed to clinical psychosis, in which these alterations are present. Subclinical and cognitive assessments were obtained in 203 participants from the general population by means of the Community Assessment of Psychic Experiences, the Brief Assessment of Cognition in Schizophrenia, the Wechsler Adults Intelligence Scale and the Wisconsin Card Sorting Test. The positive and negative subclinical symptoms and their relationship with age and cognition were examined, followed by assessing the influence of subclinical depression scores on the possible relationships between those subclinical psychotic symptoms and cognitive deficits. Inverse relationships were found between frequency in the Community Assessment of Psychic Experiences positive dimension and motor speed, and frequency and distress in the Community Assessment of Psychic Experiences negative dimension and motor speed. A direct relationship was also found between distress scores of the positive dimension and executive functions. Both positive and negative subclinical symptoms were related to depression scores. Psychotic symptoms, similar to those in the clinical population, may be associated with cognitive deficits in the general population. Copyright © 2015 SEP y SEPB. Published by Elsevier España. All rights reserved.

Subclinical nutritional rickets among adolescents in Kaghan Valley.

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Shah, Tanveer Hussain; Hassan, Mukhtiar; Siddiqui, Tahir Saeed

2014-09-01

To determine the occurrence of subclinical rickets and its causing factors among adolescent students of schools in Kaghan Valley, Pakistan. Observation cross-sectional study. Department of Biochemistry and Health Sciences, Hazara University, Mansehra, Ayub Medical College and Teaching Hospital, Abbottabad, from March to April 2012. Sixty seven students (34 boys and 33 girls) age between 11 - 16 years included in the study from different schools of Kaghan Valley, Pakistan. Characteristic, serum biochemical and nutritional status were measured for all the participants. On the basis of biochemical finding the boys and girls students were divided in to two groups, normal subjects and subclinical rickets (absent symptoms with altered biochemistry). Twenty six participants, 19 (73%) girls and 07 (27%) boys had biochemical abnormality but no clinical signs and symptoms of rickets. Low vitamin D and high alkaline phosphatase level were observed in 26 (100%), 21 (81%), low calcium in 17 (65%) and low phosphorus 7 (27%) subjects with subclinical rickets. None had high parathormone level above normal range. Nutritional intake of calcium, phosphorus and vitamin D was found less than the recommended daily intake in all the participants. Subclinical rickets is common problem among adolescent students especially in girls which is due to low nutritional intakes and avoidance of sunshine due to environmental and traditional impacts.

The diagnostic effects of s-TSH and TRH stimulating test on subclinical thyroid function

International Nuclear Information System (INIS)

Lu Shujun; Wang Wenliang; Lu Shuyan; Zheng Linong; Hu Changjun; Fang Xiaozheng; Zheng Huian; Ma Meizhen

2002-01-01

The study was carried out to investigate the diagnostic effects of supersensitive TSH on diagnosing subclinical thyroid function with only once s-TSH detection and with TRH stimulating tests. TRH stimulating tests have been undertaken for 90 patients with different thyroid disease and 58 normal subjects. Diagnostic basal levels of s-TSH test in control group, subclinical hyperthyroidism group and subclinical hypothyroidism group were 2.20 +- 1.85 mIU/L, 0.54 +- 0.3 mIU/L and 9.08 +- 6.3 mIU/L, respectively, the levels of subclinical hyperthyroidism and subclinical hypothyroidism group were significantly higher than that of normal subjects group (P s -TSH>30 mIU/L. Dynamic observing of TRH stimulating tests have more effect than that of only once s-TSH detection in diagnosing subclinical thyroid function

Comparison of QT dispersion between subclinical hypothyroid and euthyroid patients

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Muharrem Kıskaç

2010-06-01

Full Text Available Objectives: The aim of this study was to investigate the relationship between subclinical hypothyroid and QTc dispersionindicating local heterogeneity in repolarization of myocardium, which is well known as independent cardiac risk factor for sudden death and ventricular arrhythmia.Materials and Methods: We compared QTc dispersion of subclinical hypothyroid patients, after treatment and healthy control group. We included a total of 50 patients with 41 women and 9 men in the study group. Electrocardiographywith 12 derivations, thyroid hormones, serum electrolytes and basic biochemical parameters were measured.The control group consisted of 25 healthy individuals.QT distances were calculated by using Bazet formula. The difference between the longest QTc and the shortest QTc distance was accepted as QTc dispersion (QTcd.Results: Comparison of subclinical hypothyroid patients, their euthyroidic period after treatment and healthy controlgroup, gave no significant differences in age, body weight, body mass index and free thyroxin values. However,significant difference was found in durations of QTd and QTcd between the subclinical hypothyroid, the control and the euthyroidic groups (p0.05.Conclusion: Our results suggested that subclinical hypothyroidpatients had longer QTc dispersion compared to euthyroidic period and healthy subjects. However there was no QTcd difference between the euthyroidic period and healthy control group.

Prevalence and predictors of subclinical seizures during scalp video-EEG monitoring in patients with epilepsy.

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Jin, Bo; Wang, Shan; Yang, Linglin; Shen, Chunhong; Ding, Yao; Guo, Yi; Wang, Zhongjin; Zhu, Junming; Wang, Shuang; Ding, Meiping

2017-08-01

This study first aimed to establish the prevalence and predictors of subclinical seizures in patients with epilepsy undergoing video electroencephalographic monitoring, then to evaluate the relationship of sleep/wake and circadian pattern with subclinical seizures. We retrospectively reviewed the charts of 742 consecutive patients admitted to our epilepsy center between July 2012 and October 2014. Demographic, electro-clinical data and neuroimage were collected. A total of 148 subclinical seizures were detected in 39 patients (5.3%) during video electroencephalographic monitoring. The mean duration of subclinical seizures was 47.18 s (range, 5-311). Pharmacoresistant epilepsy, abnormal MRI and the presence of interictal epileptiform discharges were independently associated with subclinical seizures in multivariate logistic regression analysis. Subclinical seizures helped localizing the presumed epileptogenic zone in 24 (61.5%) patients, and suggested multifocal epilepsy in five (12.8%). In addition, subclinical seizures occurred more frequently in sleep and night than wakefulness and daytime, respectively, and they were more likely seen between 21:00-03:00 h, and less likely seen between 09:00-12:00 h. Thirty patients (76.9%) had their first subclinical seizures within the first 24 h of monitoring while only 7.7% of patients had their first subclinical seizures detected within 20 min. Subclinical seizures are not uncommon in patients with epilepsy, particularly in those with pharmacoresistant epilepsy, abnormal MRI or interictal epileptiform discharges. Subclinical seizures occur in specific circadian patterns and in specific sleep/wake distributions. A 20-min VEEG monitoring might not be long enough to allow for their detection.

Plasma apolipoprotein C-III levels, triglycerides, and coronary artery calcification in type 2 diabetics.

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Qamar, Arman; Khetarpal, Sumeet A; Khera, Amit V; Qasim, Atif; Rader, Daniel J; Reilly, Muredach P

2015-08-01

Triglyceride-rich lipoproteins have emerged as causal risk factors for developing coronary heart disease independent of low-density lipoprotein cholesterol levels. Apolipoprotein C-III (ApoC-III) modulates triglyceride-rich lipoprotein metabolism through inhibition of lipoprotein lipase and hepatic uptake of triglyceride-rich lipoproteins. Mutations causing loss-of-function of ApoC-III lower triglycerides and reduce coronary heart disease risk, suggestive of a causal role for ApoC-III. Little data exist about the relationship of ApoC-III, triglycerides, and atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Here, we examined the relationships between plasma ApoC-III, triglycerides, and coronary artery calcification in patients with T2DM. Plasma ApoC-III levels were measured in a cross-sectional study of 1422 subjects with T2DM but without clinically manifest coronary heart disease. ApoC-III levels were positively associated with total cholesterol (Spearman r=0.36), triglycerides (r=0.59), low-density lipoprotein cholesterol (r=0.16), fasting glucose (r=0.16), and glycosylated hemoglobin (r=0.12; Ptriglycerides (Tobit regression ratio, 1.43; 95% confidence interval, 0.94-2.18; P=0.086) and separately for very low-density lipoprotein cholesterol (Tobit regression ratio, 1.14; 95% confidence interval, 0.75-1.71; P=0.53). In persons with T2DM, increased plasma ApoC-III is associated with higher triglycerides, less favorable cardiometabolic phenotypes, and higher coronary artery calcification, a measure of subclinical atherosclerosis. Therapeutic inhibition of ApoC-III may thus be a novel strategy for reducing plasma triglyceride-rich lipoproteins and cardiovascular risk in T2DM. © 2015 American Heart Association, Inc.

Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke

DEFF Research Database (Denmark)

Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J

2015-01-01

OBJECTIVE: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished...... studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels....... DATA EXTRACTION AND SYNTHESIS: We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared...

Myxedema coma in a patient with subclinical hypothyroidism.

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Mallipedhi, Akhila; Vali, Hamza; Okosieme, Onyebuchi

2011-01-01

Myxedema coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of myxedema coma. A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3-24.5), FT3 2.7 pmol/L (reference range 2.67-7.03), and thyrotropin 6.09 mU/L (reference range 0.4-4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and coma. Biochemical profile showed hyponatremia, elevated creatinine phosphokinase, metabolic acidosis, and renal failure. An echocardiogram revealed a moderate-sized pericardial effusion. We diagnosed myxedema coma and started treatment with intravenous T3. She responded dramatically with improvement in level of consciousness and normalization of metabolic parameters. We found no explanation other than hypothyroidism to account for the presentation. Adrenocorticotrophic hormone (ACTH) stimulation tests excluded adrenal insufficiency, and serum gonadotrophins were within the normal reference range. FT4 estimation by equilibrium dialysis excluded analytical interference, and molecular analysis for the thyroid hormone receptor β gene associated with thyroid hormone resistance was negative. To the best of our knowledge this is the first report of myxedema coma in a patient with subclinical hypothyroidism. The reason for normal thyroid hormone levels is unclear but may reflect deviation from a higher pre-morbid set-point. The case

Subclinical hypercortisolism in patients with adrenal incidentaloma

International Nuclear Information System (INIS)

Fernández, B.; Betancourt, V.C.; Padilla, P.; De la Barca, M.

2016-01-01

Subclinical hypercortisolism (HS) is diagnosed in a patient with no Cushing's syndrome manifest phenotype but with autonomic cortisol secretion. Harmful effects of chronic subtle excess of cortisol have been demonstrated, such as hypertension (AHT), type 2 diabetes mellitus (DM2) or glucose intolerance, obesity, osteoporosis, vertebral fractures and dyslipidemia. It has been suggested that subclinical hypercortisolism may itself be a vascular risk factor. In order to identify the presence of subclinical hypercortisolism and its main clinical manifestations in patients with adrenal incidentalomas treated at the endocrinology service of the 'Arnaldo Milian Castro' Clinical Surgical Hospital, a descriptive cross-sectional investigation was carried out from 2012 to 2015 The sample of intentional type was made up of 34 patients older than 18 years and diagnosis of adrenal incidentalomas. Age, sex, toxic habits, questioning results, physical examination and the necessary diagnostic investigations were analyzed. The results showed a predominance of females, over 60 years old, with toxic habits and family and personal history of hypertension and DM2. Palpitations, low back pain, asthenia and obesity with pigmentation of the skin were the most frequent clinical manifestations. Hyperglycemia, dyslipidemia, and elevated levels of cortisol occurred in the majority of patients. Imaging diagnosis showed left lesions and less than 4.0 cm and adrenal adenoma was the most frequent histopathological diagnosis. It was demonstrated that subclinical hypercortisolism is present in an important group of patients with adrenal incidentalomas, is not as asymptomatic, and is related to the presence of vascular risk factors, and other comorbidities

Altered fructosamine and lipid fractions in subclinical hypothyroidism.

Science.gov (United States)

Udupa, Sridevi V; Manjrekar, Poornima A; Udupa, Vinit A; Vivian, D'Souza

2013-01-01

Thyroid function disorders lead to changes in the lipoprotein metabolism. To study the lipid and the glycaemic abnormalities in the subclinical hypothyroidism cases and to compare the same with the euthyroid, overt hypothyroid and the hyperthyroid subjects. Four groups, euthyroid (Group-I), hypothyroid (Group-II), subclinical hypothyroid (Group-III) and hyperthyroid (Group-IV), which consisted of 30 subjects each, of either sex, who were aged 25-55 years, underwent Fasting Plasma Glucose (FPG), fructosamine, lipid profile and total T3, T4 and TSH estimations. The subjects who were on lipid lowering or thyroid disorder drugs and known diabetics were excluded from the study. In Group-III, all the lipid fractions were comparable to those of Group-II and they were significantly deranged, as compared to those of Group-I. The fructosamine levels were significantly higher in Group-II and Group-III (phypothyrodism, the subclinical hypothyroid cases also need to be treated similarly. The fructosamine values which are largely in excess of the FPG values, indicate a higher propensity to glycation and a decreased turnover of the proteins in the hypothyroid and the subclinical hypothyroid pools. Vice versa is true of the hyperthyroid pool. Fructosamine can be included in the thyroid work up of the patients to assess the metabolic function and the subsequent response after the initiation of the therapy.

Subclinical Nutritional Rickets Among Adolescents in Kaghan Valley

International Nuclear Information System (INIS)

Shah, T. H.; Hassan, M.; Siddiqui, T. S.

2014-01-01

Objective: To determine the occurrence of subclinical rickets and its causing factors among adolescent students of schools in Kaghan Valley, Pakistan. Study Design: Observation cross-sectional study. Place and Duration of Study: Department of Biochemistry and Health Sciences, Hazara University, Mansehra, Ayub Medical College and Teaching Hospital, Abbottabad, from March to April 2012. Methodology: Sixty seven students (34 boys and 33 girls) age between 11 - 16 years included in the study from different schools of Kaghan Valley, Pakistan. Characteristic, serum biochemical and nutritional status were measured for all the participants. On the basis of biochemical finding the boys and girls students were divided in to two groups, normal subjects and subclinical rickets (absent symptoms with altered biochemistry). Results: Twenty six participants, 19 (73%) girls and 07 (27%) boys had biochemical abnormality but no clinical signs and symptoms of rickets. Low vitamin D and high alkaline phosphatase level were observed in 26 (100%), 21 (81%), low calcium in 17 (65%) and low phosphorus 7 (27%) subjects with subclinical rickets. None had high parathormone level above normal range. Nutritional intake of calcium, phosphorus and vitamin D was found less than the recommended daily intake in all the participants. Conclusion: Subclinical rickets is common problem among adolescent students especially in girls which is due to low nutritional intakes and avoidance of sunshine due to environmental and traditional impacts. (author)

Subclinical Laminitis in Dairy Cattle: 205 Selected Cases

OpenAIRE

BAKIR, Ali BELGE Bahtiyar

2005-01-01

The economic importance of lameness in dairy cattle has newly been recognized in Turkey. Lameness incidence in Turkey has been reported to be between 13% and 58%, which is similar to that of other countries where 4% and 55% incidence rates have been reported. The objective of this study was to determine the prevalence of sole lesions associated with subclinical laminitis in the hooves of dairy cattle in Van, Turkey. The risk factors for subclinical laminitis are proposed and discussed. The so...

Concurrent and Sustained Cumulative Effects of Adolescent Marijuana Use on Subclinical Psychotic Symptoms.

Science.gov (United States)

Bechtold, Jordan; Hipwell, Alison; Lewis, David A; Loeber, Rolf; Pardini, Dustin

2016-08-01

Adolescents who regularly use marijuana may be at heightened risk of developing subclinical and clinical psychotic symptoms. However, this association could be explained by reverse causation or other factors. To address these limitations, the current study examined whether adolescents who engage in regular marijuana use exhibit a systematic increase in subclinical psychotic symptoms that persists during periods of sustained abstinence. The sample comprised 1,009 boys who were recruited in 1st and 7th grades. Self-reported frequency of marijuana use, subclinical psychotic symptoms, and several time-varying confounds (e.g., other substance use, internalizing/externalizing problems) were recorded annually from age 13 to 18. Fixed-effects (within-individual change) models examined whether adolescents exhibited an increase in their subclinical psychotic symptoms as a function of their recent and/or cumulative history of regular marijuana use and whether these effects were sustained following abstinence. Models controlled for all time-stable factors (default) and several time-varying covariates as potential confounds. For each year adolescent boys engaged in regular marijuana use, their expected level of subsequent subclinical psychotic symptoms rose by 21% and their expected odds of experiencing subsequent subclinical paranoia or hallucinations rose by 133% and 92%, respectively. The effect of prior regular marijuana use on subsequent subclinical psychotic symptoms persisted even when adolescents stopped using marijuana for a year. These effects were after controlling for all time-stable and several time-varying confounds. No support was found for reverse causation. These results suggest that regular marijuana use may significantly increase the risk that an adolescent will experience persistent subclinical psychotic symptoms.

The Progression and Early detection of Subclinical Atherosclerosis (PESA) study

DEFF Research Database (Denmark)

Fernández-Ortiz, Antonio; Jiménez-Borreguero, L Jesús; Peñalvo, José L

2013-01-01

The presence of subclinical atherosclerosis is a likely predictor of cardiovascular events; however, factors associated with the early stages and progression of atherosclerosis are poorly defined.......The presence of subclinical atherosclerosis is a likely predictor of cardiovascular events; however, factors associated with the early stages and progression of atherosclerosis are poorly defined....

Non-Autoimmune Subclinical and Overt Hypothyroidism in Idiopathic Steroid-resistant Nephrotic Syndrome in Children.

Science.gov (United States)

Marimuthu, Vidhya; Krishnamurthy, Sriram; Rajappa, Medha

2017-11-15

To evaluate the frequency of non-autoimmune subclinical and overt hypothyroidism in children with idiopathic steroid-resistant nephrotic syndrome (SRNS). This cross-sectional study recruited 30 children (age 1-18 y) with idiopathic SRNS; and 30 healthy controls. Serum T3, T4 and TSH were performed in cases as well as controls. Anti-thyroid peroxidase and anti-thyroglobulin antibody tests were performed in all cases. Non-autoimmune subclinical or overt hypothyroidism was detected in 10 out of 30 children with idiopathic SRNS; 2 had overt hypothyroidism, while 8 patients had subclinical hypothyroidism. Children with SRNS had a mean (SD) TSH value 4.55 (4.64) mIU/L that was higher as compared to controls (1.88 (1.04) mIU/L) (Phypothyroidism (2 cases) and grade III subclinical hypothyroidism (1 case) were subsequently started on levothyroxine therapy. The prevalence of subclinical and overt hypothyroidism seems to be high in idiopathic SRNS, with almost one-third of children having overt or subclinical non-autoimmune hypothyroidism.

A comparison of clinical vs subclinical skin pickers in Israel.

Science.gov (United States)

Keuthen, Nancy J; Curley, Erin E; Tung, Esther S; Ittah, Karen; Qasem, Atheer; Murad, Sari; Odlaug, Brian L; Leibovici, Vera

2016-05-01

Skin-picking disorder (SPD) was recognized as its own entity for the first time in DSM-5. The existing SPD literature is limited and, to date, no study has examined the differences between clinical and sub- clinical SPD. Identifying differences between these 2 groups may improve diagnostic accuracy, treatment, and prevention efforts. Israeli adults (N = 4,325) from 2 previous studies were examined for the presence of clinical and subclinical SPD. Individuals with clinical SPD (n = 150) vs subclinical SPD (n = 219) were compared on skin-picking characteristics, psychological phenomena, and clinical correlates. There were many similarities between clinical and subclinical skin pickers. Individuals with clinical SPD, however, had more severe skin picking, greater associated functional impairment, greater perceived stress, and greater depressive and obsessive-compulsive symptoms, and were also more likely to have a first-degree relative with SPD. This study suggests that although there are some similarities between clinical and subclinical SPD, there also are distinct differences in the clinical presentation. Understanding these differences may be an important factor in treatment and prevention planning.

Elevated plasma plasminogen activator inhibitor type-1 is an independent predictor of coronary microvascular dysfunction in hypertension

International Nuclear Information System (INIS)

Naya, Masanao; Tsukamoto, Takahiro; Inubushi, Masayuki; Morita, Koichi; Katoh, Chietsugu; Furumoto, Tomoo; Fujii, Satoshi; Tsutsui, Hiroyuki; Tamaki, Nagara

2007-01-01

Elevated plasma plasminogen activator inhibitor-1 (PAI-1) is related to cardiovascular events, but its role in subclinical coronary microvascular dysfunction remains unknown. Thus, in the present study it was investigated whether elevated plasma PAI-1 activity is associated with coronary microvascular dysfunction in hypertensive patients. Thirty patients with untreated essential hypertension and 10 age-matched healthy controls were studied prospectively. Myocardial blood flow (MBF) was measured by using 15 O-water positron emission tomography. Clinical variables associated with atherosclerosis (low-density lipoprotein-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglyceride, homeostasis model assessment (HOMA-IR), and PAI-1 activity) were assessed to determine their involvement in coronary microvascular dysfunction. Adenosine triphosphate (ATP)-induced hyperemic MBF and coronary flow reserve (CFR) were significantly lower in hypertensive patients than in healthy controls (ATP-induced MBF: 2.77±0.82 vs 3.49±0.71 ml·g -1 ·min -1 ; p<0.02 and CFR: 2.95±1.06 vs 4.25±0.69; p<0.001). By univariate analysis, CFR was positively correlated with HDL-cholesterol (r=0.46, p<0.02), and inversely with HOMA-IR (r=-0.39, p<0.05) and PAI-1 activity (r=-0.61, p<0.001). By multivariate analysis, elevated PAI-1 activity remained a significant independent determinant of diminished CFR. Elevated plasma PAI-1 activity was independently associated with coronary microvascular dysfunction, which suggests that plasma PAI-1 activity is an important clue linking hypofibrinolysis to the development of atherosclerosis. (author)

Selected markers of endothelial dysfunction in patients with subclinical and overt hyperthyroidism

International Nuclear Information System (INIS)

Modzelewska, A.; Szelachowska, M.; Zonenberg, A.; Abdelrazek, S.; Nikolajuk, A.; Gorska, M.

2006-01-01

Introduction: There are many factors causing endothelial dysfunction. The aim was to observe chosen markers of endothelial function in patients with subclinical and overt hyperthyroidism. Material and methods: We studied 97 patients with hyperthyroidism: 51 with subclinical (44 F/7 M; mean age 49.3 ± 15.9 y) and 46 patients with overt (39 F/7 M, mean age 50.4 ± 13.2 y). The control comprised of 39 healthy volunteers (26 F/13 M, mean age 47.5 ± 11.8 y). Concentration of TSH, FT3, FT4 were measured by MEIA, TPO Ab, TG Ab, E-selectin, interleukin 6, VCAM-1, ICAM-1 by ELISA. Results: The goiter was found in 71 persons 63F/8M, mean age 49.9 ± 15.3 y, (42-subclinical, 29-overt). Morbus Graves--Basedow was diagnosed in 26 persons, 20 F/6 M, mean age 49.5 ± 12.8 y (9-subclinical, 17-overt). There were no significant differences serum concentration of E-selectin, IL-6, ICAM-1 in patients with subclinical and overt hyperthyroidism compared to the control. Statistically significant differences were shown between concentration of IL-6 in patients with Graves-Basedow compared with the control (p < 0.05). Significance of VCAM-1 values were found in the patients with subclinical and overt hyperthyroidism compared to the control (p < 0.001; p < 0.001, respectively). Conclusions: Among persons with overt and subclinical hyperthyroidism occurs endothelial dysfunction which doesn't depends on exciting cause of thyrotoxicosis but on degree of hyperthyroidism. Elevated concentrations of endothelial markers may confirm that persons with thyroid disorders are extremely exposed to the occurrence of the cardiovascular diseases. (author)

Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy.

Science.gov (United States)

Casey, Brian M; Thom, Elizabeth A; Peaceman, Alan M; Varner, Michael W; Sorokin, Yoram; Hirtz, Deborah G; Reddy, Uma M; Wapner, Ronald J; Thorp, John M; Saade, George; Tita, Alan T N; Rouse, Dwight J; Sibai, Baha; Iams, Jay D; Mercer, Brian M; Tolosa, Jorge; Caritis, Steve N; VanDorsten, J Peter

2017-03-02

Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4.00 mU or more per liter and a normal free thyroxine (T 4 ) level (0.86 to 1.90 ng per deciliter [11 to 24 pmol per liter]), and for hypothyroxinemia, defined as a normal thyrotropin level (0.08 to 3.99 mU per liter) and a low free T 4 level (hypothyroidism underwent randomization at a mean of 16.7 weeks of gestation, and 526 with hypothyroxinemia at a mean of 17.8 weeks of gestation. In the subclinical hypothyroidism trial, the median IQ score of the children was 97 (95% confidence interval [CI], 94 to 99) in the levothyroxine group and 94 (95% CI, 92 to 96) in the placebo group (P=0.71). In the hypothyroxinemia trial, the median IQ score was 94 (95% CI, 91 to 95) in the levothyroxine group and 91 (95% CI, 89 to 93) in the placebo group (P=0.30). In each trial, IQ scores were missing for 4% of the children. There were no significant between-group differences in either trial in any other neurocognitive or pregnancy outcomes or in the incidence of adverse events, which was low in both groups. Treatment for subclinical hypothyroidism or hypothyroxinemia beginning between 8 and 20 weeks of gestation did not result in significantly better cognitive outcomes in children through 5 years of age than no treatment for those conditions. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00388297 .).

Stochastic modelling to evaluate the economic efficiency of treatment of chronic subclinical mastitis

OpenAIRE

Steeneveld, W.; Hogeveen, H.; Borne, van den, B.H.P.; Swinkels, J.M.

2006-01-01

Treatment of subclinical mastitis is traditionally no common practice. However, some veterinarians regard treatment of some types of subclinical mastitis to be effective. The goal of this research was to develop a stochastic Monte Carlo simulation model to support decisions around treatment of chronic subclinical mastitis caused by Streptococcus uberis. Factors in the model include, amongst others, the probability of spontaneous cure, probability of the cow becoming clinically diseased, trans...

A novel ultrasound-based vascular calcification score (CALCS) to detect subclinical atherosclerosis.

Science.gov (United States)

Flore, R; Zocco, M A; Ainora, M E; Fonnesu, C; Nesci, A; Gasbarrini, A; Ponziani, F R

2018-02-01

To quantify non-coronary vascular calcifications (VC) in asymptomatic patients at low-intermediate cardiovascular risk by a new color Doppler ultrasound (DUS)-based score (the carotid, aortic, lower limbs calcium score, CALCs), and to correlate this score with classical parameters associated with cardiovascular risk [carotid intima media thickness (IMT), and arterial stiffness (AS)]. All consecutive asymptomatic patients who underwent a screening DUS of non-coronary circulation were evaluated and patients at low-intermediate cardiovascular risk were selected according to Framingham risk score (FRS). Among them, we enrolled 70 patients with US evidence of VC and 71 age, sex and FRS matched controls. The presence of VC was correlated with classical markers of cardiovascular risk, such as AS and intima-media thickness (IMT). AS, expressed as pulse wave velocity (PWV) and arterial distensibility, carotid IMT and CALCs were measured for both groups. AS and c-IMT were assessed by a new Radio-Frequency (RF) DUS-based method. CALCs was generated by our previously described B-mode DUS-based method according to number/size of VC in 11 non-coronary segments (range 0-33). Patients with VC presented higher AS and IMT values than controls (PWV 8.34±0.98 m/s vs. 6.74±0.68 m/s, p<0.0001; arterial distensibility 267±12 mm vs. 315±65 mm, p=0.001; IMT 687±132 mm vs. 572±91 mm, p<0.0001). Mean CALCs of patients with VC was 8.41±7.78. CALCs were significantly correlated with c-IMT (p<0.0001; r=0.3), PWV (p<0.0001; r=0.4) and arterial distensibility (p=0.002; r=-0.1). DUS-based CALCs is highly correlated with other validated markers of subclinical atherosclerosis, such as c-IMT and AS. Our results demonstrated the ability of CALCs to identify individual predictive factors beyond the traditional risk factors by quantifying an interesting and novel step of the atherogenic process. Future studies on larger series and with adequate follow up are necessary to confirm these results and

Personality traits in subclinical and non-obsessive-compulsive volunteers and their parents.

Science.gov (United States)

Frost, R O; Steketee, G; Cohn, L; Griess, K

1994-01-01

Theorists from a variety of perspectives have asserted that obsessive compulsives are more risk-aversive, perfectionistic and guilt-ridden than non-obsessive compulsives, and that these characteristics are central features of the disorder. Furthermore, several have hypothesized that the parents of obsessive compulsives are characterized by risk-aversion, perfectionism, and high levels of criticism. Little research exists which corroborates these hypotheses, however. The present investigation examined these hypotheses among subclinical obsessive compulsives. In two different samples, subclinical obsessive compulsives were found to be more risk-aversive, perfectionistic, and guilt-ridden. Subclinical obsessive compulsives also perceived their parents to be more overprotective. The findings regarding other parental traits were less clear. There was some support for the hypothesis that the parents of subclinical obsessive compulsives are more risk-aversive, and that fathers are more critical and perfectionistic.

Electromyographic Findings in Overt Hypothyroidism and Subclinical Hypothyroidism

Directory of Open Access Journals (Sweden)

Emel Oğuz Akarsu

2013-12-01

Full Text Available OBJECTIVE: Hypothyroidism may cause neurologic signs and symptoms as its effects neuromuscular system like many other systems. Subclinical hypothyroidism is the most common thyroid dysfuntion, it may cause neuromuscular signs and symptoms. In this retrospective study, it is aimed to compare neuromuscular symptoms and electromyographic (EMG manifestations between hypothyroid patients and control group with normal thyroid function and without a disease causing polyneuropathy. METHODS: 31 overt hypothyroidic, 139 subclinic hypothyroidic patients and 50 individuals with normal thyroid function, without a disease causing polyneuropathy, as control group whom made EMG for another reason were included to the study. Neuromuscular symptoms, neurological examination and electrophysiological findings was obtained from the patient records. RESULTS: In our study, we observed frequent neuromuscular complaints such as fatigue, morning stiffness, cramp, general pain and paresthesia in favor of both for overt and subclinic hypothyroidism. Carpal Tunnel Syndrom(CTS, was statistically higher in overt hypothyroidism group than control group. CTS was also observed higher in subclinic hypothyroidism group when compared with control group but it didn't reach to statistical significance. We did not detect polyneuropathy in any group. Motor nerve velocity and compound muscle action potential amplitudes were found to be statistically significant difference between hypothyroid ve control group. CONCLUSION: Since motor fibres' and neuromuscular area's being affected in hypothyroidism, which we interpret to happen due to basal metabolism's slowing down, can show a significant recovery after thyroid replacement therapy. We consider that, in further studies, comparison of electrophysiological findings after treatment with the findings of pre -treatment is necessary

Subclinical hypothyroidism after vascular complicated pregnancy

NARCIS (Netherlands)

Zanden, M. van der; Hop-de Groot, R.J.; Sweep, F.C.; Ross, H.A.; Heijer, M. den; Spaanderman, M.E.A.

2013-01-01

OBJECTIVE: Women with a history of vascular complicated pregnancy are at risk for developing remote cardiovascular disease. It is associated with underlying cardiovascular risk factors both jeopardizing trophoblast and vascular function. Subclinical hypothyroidism may relate to both conditions.

Subclinical Hypothyroidism and Survival: The Effects of Heart Failure and Race

Science.gov (United States)

Curhan, Gary C.; Alexander, Erik K.; Bhan, Ishir; Brunelli, Steven M.

2013-01-01

Context: Studies examining the association between subclinical hypothyroidism and mortality have yielded conflicting results. Emerging data suggest these associations may depend upon underlying congestive heart failure (CHF) and/or race, but this has not been empirically determined. Objective: Our objective was to examine the association between subclinical hypothyroidism and hypothyroidism overall with mortality according to pre-existing CHF and race. Design and Participants: We examined the associations of subclinical hypothyroidism (TSH higher than assay upper limit of normal; total T4 within reference) and hypothyroidism overall (TSH higher than assay upper limit of normal; total T4 below lower limit of normal or within reference) with all-cause mortality among Third National Health and Nutrition Examination Survey participants stratified by CHF and race using multivariable Cox models. To confirm whether differences between strata were statistically significant, we tested for interaction on the basis of CHF (separately) and race by likelihood ratio testing. Results: There were 14 130 (95.0%) euthyroid controls and 749 (5.0%) participants with hypothyroidism, 691 (4.6%) of whom had subclinical disease. Subclinical hypothyroidism vs euthyroidism was associated with greater mortality in those with CHF but not in those without: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) = 1.44 (1.01–2.06) and 0.97 (0.85–1.11), respectively (P interaction = .03). Similar findings were observed for hypothyroidism overall. Hypothyroidism overall vs euthyroidism was associated with greater mortality in Black participants (HR = 1.44 [95% CI = 1.03–2.03]) but not in non-Blacks (HR = 0.95 [95% CI = 0.83–1.08]) (P interaction = .03). Conclusion: Among participants with CHF, subclinical hypothyroidism and hypothyroidism overall are associated with greater death risk. Additional studies are needed to confirm findings and explore possible mechanisms for the

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

MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy.

Science.gov (United States)

Carlé, Allan; Andersen, Stine Linding; Boelaert, Kristien; Laurberg, Peter

2017-06-01

Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven. © 2017 European Society of Endocrinology.

The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium.

Science.gov (United States)

Wong, Nathan D; Sciammarella, Maria G; Polk, Donna; Gallagher, Amy; Miranda-Peats, Lisa; Whitcomb, Brian; Hachamovitch, Rory; Friedman, John D; Hayes, Sean; Berman, Daniel S

2003-05-07

We compared the prevalence and extent of coronary artery calcium (CAC) among persons with the metabolic syndrome (MetS), diabetes, and neither condition. The prevalence and extent of CAC has not been compared among those with MetS, diabetes, or neither condition. Of 1,823 persons (36% female) age 20 to 79 years who had screening for CAC by computed tomography, 279 had MetS, 150 had diabetes, and the remainder (n = 1,394) had neither condition. Metabolic syndrome was defined with >or=3 of the following: body mass index >or=30 kg/m(2); high-density lipoprotein cholesterol or=150 mg/dl; blood pressure >or=130/85 mm Hg or on treatment; or fasting glucose 110 to 125 mg/dl. The prevalence and odds of any and significant (>or=75th percentile) CAC among these groups and by number of MetS risk factors were determined. Those with neither MetS nor diabetes, MetS, or diabetes had a prevalence of CAC of 53.5%, 58.8%, and 75.3% (p 20% 10-year risk of CHD or CAC >or=75th percentile for age and gender. Risk factor-adjusted odds for the presence of CAC were 1.40 (95% confidence interval [CI] 1.05 to 1.87) among those with MetS and 1.67 (95% CI 1.12 to 2.50) among those with diabetes, versus those with neither condition. Those with MetS or diabetes have an increased likelihood of CAC compared with those having neither condition.

The diagnostic value of late-night salivary cortisol for diagnosis of subclinical Cushing's syndrome.

Science.gov (United States)

Kuzu, Idris; Zuhur, Sayid Shafi; Demir, Nazan; Aktas, Gokce; Yener Ozturk, Feyza; Altuntas, Yuksel

2016-01-01

Late-night salivary cortisol is a frequently used and easily implemented diagnostically valuable test for the diagnosis of overt Cushing's syndrome. The use of late-night salivary cortisol in the diagnosis of subclinical Cushing's syndrome is somewhat controversial. In this study, we aimed to determine the diagnostic value of late-night salivary cortisol in diagnosing subclinical Cushing's syndrome and compare it with 24-hour urinary free cortisol levels (UFC). The study consisted of 33 cases of subclinical Cushing's syndrome, 59 cases of non-functioning adrenal adenoma, and 41 control subjects. Late-night salivary cortisol and UFC were measured in all the cases. The diagnosis of subclinical Cushing's syndrome was based on combined results of 1 mg dexamethasone suppression test > 1.8 μg/dL and ACTH Cushing's syndrome were significantly higher than in subjects with non-functioning adrenal adenoma and the control group (p Cushing's syndrome were determined as 82% and 60%, respectively. Using a cut-off value of 137 μg/day, the sensitivity and specificity of UFC was determined as 18% and 90%, respectively. Because the sensitivity of late-night salivary cortisol for the diagnosis of subclinical Cushing's syndrome is limited, using it as the sole screening test for subclinical Cushing's syndrome may lead to false negative results. However, using it as an adjunct test to other tests may be beneficial in the diagnosis of subclinical Cushing's syndrome. (Endokrynol Pol 2016; 67 (5): 487-492).

SUBCLINICAL HYPOTHYROIDISM CURRENT CONCEPTS & M ANAGEMENT STRATEGEIES

Directory of Open Access Journals (Sweden)

Radha Krishnan

2015-05-01

Full Text Available Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone ( TSH and normal free T3 & T4 , without clinical features of hypothyroidism . Clinical significance of SCH remains uncertain and controversial . Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms . There are still controversies surrounding SCH and associated risk of various cardiovascular diseases ( CVDs , pregnancy outcomes , neuropsychiatric issues , metabolic syndrome , and dyslipidemia . This review will summarize the current data related to the effects of SCH on cardiovascular risk , SCH in pregnancy , in dyslipedemia and clinical guidelines on management of this condition . The evidence has been updated by a Pub med search on the risks and treatment of subclinical hypothyroidism of most recent articles published until March 2015

Sub-clinical assessment of atopic dermatitis severity using angiographic optical coherence tomography

Science.gov (United States)

Byers, Robert A.; Maiti, Raman; Danby, Simon G.; Pang, Elaine J.; Mitchell, Bethany; Carré, Matt J.; Lewis, Roger; Cork, Michael J.; Matcher, Stephen J.

2018-01-01

Measurement of sub-clinical atopic dermatitis (AD) is important for determining how long therapies should be continued after clinical clearance of visible AD lesions. An important biomarker of sub-clinical AD is epidermal hypertrophy, the structural measures of which often make optical coherence tomography (OCT) challenging due to the lack of a clearly delineated dermal-epidermal junction in AD patients. Alternatively, angiographic OCT measurements of vascular depth and morphology may represent a robust biomarker for quantifying the severity of clinical and sub-clinical AD. To investigate this, angiographic data sets were acquired from 32 patients with a range of AD severities. Deeper vascular layers within skin were found to correlate with increasing clinical severity. Furthermore, for AD patients exhibiting no clinical symptoms, the superficial plexus depth was found to be significantly deeper than healthy patients at both the elbow (p = 0.04) and knee (p<0.001), suggesting that sub-clinical changes in severity can be detected. Furthermore, the morphology of vessels appeared altered in patients with severe AD, with significantly different vessel diameter, length, density and fractal dimension. These metrics provide valuable insight into the sub-clinical severity of the condition, allowing the effects of treatments to be monitored past the point of clinical remission. PMID:29675335

[Subclinical hyperthyroidism].

Science.gov (United States)

Feldkamp, J

2013-10-01

Subclinical hyperthyroidism is defined as abnormal low TSH level with thyroid hormones within their reference range. This laboratory condition may be symptomatic in a relevant number of patients leading to tachycardia, sweating, nervousness, anxiety and insomnia. The risk for cardiovascular disease is increased with more frequent atrial fibrillation and increased left ventricular mass including diastolic dysfunction. Cardiovascular mortality and overall mortality surmounts the average of the normal population. Longterm TSH suppression leads to decreased bone mineral density and an increased fracture rate in the hip and in the spine. After evaluation of underlying causes, therapy should be considered, especially if TSH levels are below 0.1 mIU/l. © Georg Thieme Verlag KG Stuttgart · New York.

Autonomic nervous system function in chronic exogenous subclinical thyrotoxicosis and the effect of restoring euthyroidism.

Science.gov (United States)

Eustatia-Rutten, Carmen F A; Corssmit, Eleonora P M; Heemstra, Karen A; Smit, Johannes W A; Schoemaker, Rik C; Romijn, Johannes A; Burggraaf, Jacobus

2008-07-01

Knowledge on the relationship between the autonomic nervous system and subclinical hyperthyroidism is mainly based upon cross-sectional studies in heterogeneous patient populations, and the effect of restoration to euthyroidism in subclinical hyperthyroidism has not been studied. We investigated the long-term effects of exogenous subclinical hyperthyroidism on the autonomic nervous system and the potential effects of restoration of euthyroidism. This was a prospective single-blinded, placebo-controlled, randomized trial. The study was performed at a university hospital. A total of 25 patients who were on more than 10-yr TSH suppressive therapy after thyroidectomy was examined. Patients were studied at baseline and subsequently randomized to a 6-month thyroid hormone substitution regimen to obtain either euthyroidism or maintenance of the subclinical hyperthyroid state. Urinary excretion of catecholamines and heart rate variability were measured. Baseline data of the subclinical hyperthyroidism patients were compared with data obtained in patients with hyperthyroidism and controls. Urinary excretion of norepinephrine and vanillylmandelic acid was higher in the subclinical hyperthyroidism patients compared with controls and lower compared with patients with overt hyperthyroidism. Heart rate variability was lower in patients with hyperthyroidism, intermediate in subclinical hyperthyroidism patients, and highest in the healthy controls. No differences were observed after restoration of euthyroidism. Long-term exogenous subclinical hyperthyroidism has effects on the autonomic nervous system measured by heart rate variability and urinary catecholamine excretion. No differences were observed after restoration to euthyroidism. This may indicate the occurrence of irreversible changes or adaptation during long-term exposure to excess thyroid hormone that is not remedied by 6-month euthyroidism.

The minimum coronary artery diameter in which coronary spasm can be identified by synchrotron radiation coronary angiography

International Nuclear Information System (INIS)

Matsushita, Shonosuke; Hyodo, Kazuyuki; Imazuru, Tomohiro; Tokunaga, Chiho; Sato, Fujio; Enomoto, Yoshiharu; Hiramatsu, Yuji; Sakakibara, Yuzuru

2008-01-01

Background: Coronary vasospasm is defined as a temporary, intense narrowing of the coronary conduit artery. It brings about ischemic chest pain and becomes one of the causes of myocardial infarction. Coronary spasms are divided into two categories. One is the coronary spasm of the conduit artery and the other is the coronary microvascular spasm. Although coronary spasms are diagnosed with the images of coronary angiography, microvascular spasms cannot be diagnosed because of the limitations of conventional angiographic systems. However, synchrotron radiation coronary angiography (SRCA) can identify coronary arteries down to 100 μm in diameter in the beating heart and 50 μm in arrested heart. Aim: The purpose of this study was to confirm whether microvascular spasms could be identified or not using SRCA, and then down that size identification was possible. Methods: The Langendorff perfusion system with isolated rat hearts was employed. Krebs-Henseleit solution (KH solution) was used as a perfusate. 10 mM of 4-aminopyridine (4-AP: a voltage-gated potassium channel blocker; spasm inducer) was added to the KH solution and maintained for 5 min. SRCA was performed at pre-, during and 10 min after cessation of the KH solution with 4-AP. Coronary spasms were defined as a temporal 75% reduction of coronary arterial diameter. Results and conclusion: Multiple sizes of coronary arteries showed coronary spasms. The minimum stenosed coronary artery size was 100 μm. Since coronary microvascular spasms are seen in the arterioles (50-400 μm), coronary microvascular spasms may be diagnosed with the use of synchrotron radiation coronary angiography

Association of claw disorders with subclinical intramammary infections in Egyptian dairy cows

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Walid Refaai

2017-03-01

Full Text Available Aim: Bovine mastitis and lameness are the most common production diseases affecting dairy farms worldwide resulting in huge economic impact and impaired animal welfare. The objective of this field study was to investigate the association of infectious and non-infectious claw disorders with the occurrence of subclinical intramammary infections (IMIs diagnosed by California mastitis test (CMT in dairy cows under Egyptian conditions. Materials and Methods: A total of 43 dairy cows were included in this field study. Subclinical IMI was diagnosed by CMT on all lactating quarters of cows. A cow was considered to have subclinical IMI if it had at least one subclinically infected quarter (=3. Cows were inspected carefully for claw disorders that recorded based on type and site. Locomotion and body condition scores were also recorded for each cow in addition to the limb affected. The association between the CMT and other explanatory variables was tested by Fisher's exact test. Results: The prevalence of infectious and non-infectious claw disorders was 81.4% (35/43 and 32.6% (14/43, respectively. Digital dermatitis (DD and heel horn erosion were the most prevalent infectious type with 79% (34/43 and 58% (25/43, respectively, while wall fissure was the most identified non-infectious one 11.6% (5/43. The prevalence of claw disorders in hind limbs was 88.4% (38/43 and 11.6% (5/43 in the forelimbs. Infectious claw disorders were significantly associated with the subclinical IMI diagnosed by CMT (p<0.05. Non-infectious claw affections, locomotion score, body condition score, and the affected limb had no association with the occurrence of subclinical IMI. Conclusion: DD is the highest prevalent claw disorder observed in dairy cows in Egypt. The hind limbs are more susceptible to claw disorders than the forelimbs. Infectious type of claw disorders is significantly associated with subclinical IMI diagnosed by CMT in dairy cows under Egyptian conditions indicating

Prevalence of subclinical ketosis in dairy cattle in the Southwestern Iran and detection of cutoff point for NEFA and glucose concentrations for diagnosis of subclinical ketosis.

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Asl, Ardavan Nowroozi; Nazifi, Saeed; Ghasrodashti, Abbas Rowshan; Olyaee, Ahad

2011-06-01

Subclinical ketosis (SCK) is simply a condition marked by increased levels of circulating ketone bodies without the presence of the clinical signs of ketosis. Subclinical ketosis can cause economic losses through decreased milk production and association with preparturient diseases. Limited information is available regarding the prevalence of SCK in dairy herds in Southwestern Iran. The objectives of this study were (i) determination of the cutoff point of nonesterified fatty acids (NEFAs) and glucose concentrations for diagnosis of SCK using receiver operating characteristic (ROC) analysis, and (ii) determination of prevalence of subclinical ketosis in apparently healthy dairy cattle in Southwestern Iran. From October to December 2009, a total of 100 clinically healthy multiparous Holstein cows (3-8 years old) were randomly selected from 16 dairy herds around Kazerun, Fars Province, Iran. The cows had two-six lactations, with body weight ranging from 500 to 650 kg. Blood samples for each cow were taken at 2, 4 and 6 weeks post parturition and 3-4h after the morning feeding. The optimal cutoff point was set, by the ROC method, to >0.26 mmol/L for NEFA, and ketosis in all of the 2, 4 and 6 weeks postpartum. The results suggest that, a cut-off point of 0.26 mmol/L for NEFA concentrations can be used during early lactation for diagnosis of subclinical ketosis and making management decisions for prevention and treatment. Glucose cannot be a good criterion for diagnosis of SCK and it does not appear to be useful for monitoring subclinical ketosis. Copyright © 2011 Elsevier B.V. All rights reserved.

Thyrotrophin levels and coronary artery calcification: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

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Peixoto de Miranda, Érique José F; Bittencourt, Márcio Sommer; Staniak, Henrique Lane; Pereira, Alexandre C; Foppa, Murilo; Santos, Itamar S; Lotufo, Paulo A; Benseñor, Isabela M

2017-11-01

There is little information about the association between thyrotrophin (TSH) levels and coronary artery calcification (CAC). Our aim was to analyse the association between TSH quintiles and subclinical atherosclerosis measured by CAC, using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectional study. We excluded individuals using medications that affect thyroid function and who self-reported cardiovascular disease. We included euthyroid subjects and individuals with subclinical hypothyroidism (SCHypo) and subclinical hyperthyroidism (SCHyper). Logistic regression models evaluated CAC >100 Agatston units as the dependent variable, and increasing quintiles of TSH as the independent variable, adjusted for demographic and cardiovascular risk factors. Our sample included 3836 subjects, mean age 49 years (interquartile range 44-56); 1999 (52.1%) were female, 3551 (92.6%) were euthyroid, 239 (6.2%) had SCHypo and 46 (1.2%) had SCHyper. The frequency of women, White people and never smokers as well as body mass index and insulin resistance increased according to quintiles. The 1st quintile for TSH (0-0.99 mIU/L) was associated with CAC >100, using the 3rd quintile (1.39-1.85 mIU/L) as reference (adjusted OR=1.57, 95% CI: 1.05-2.35, P=.027), but no association was shown for the 5th quintile (2.68-35.5 mIU/L) compared to the 3rd. Restricting the analysis to euthyroid subjects did not change the results. For women, but not for men, we observed a U-shaped curve with 1st and 5th TSH quintiles associated with CAC>100. Low and low-normal (1st quintile) TSH levels were associated with CAC>100 Agatston units in a sample with subclinical thyroid disorders and euthyroid subjects. © 2017 John Wiley & Sons Ltd.

Subclinical hyperthyroidism is a risk factor for poor functional outcome after ischemic stroke.

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Wollenweber, Frank Arne; Zietemann, Vera; Gschwendtner, Andreas; Opherk, Christian; Dichgans, Martin

2013-05-01

Subclinical hyperthyroidism is associated with adverse cardiovascular events, including stroke and atrial fibrillation. However, its impact on functional outcome after stroke remains unexplored. A total of 165 consecutively recruited patients admitted for ischemic stroke were included in this observational prospective study. Blood samples were taken in the morning within 3 days after symptom onset, and patients were divided into the following 3 groups: subclinical hyperthyroidism (0.1hyperthyroidism, and 23 patients (13.9%) had subclinical hypothyroidism. Patients with subclinical hyperthyroidism had a substantially increased risk of functional disability 3 months after stroke compared with subjects with euthyroid state (odds ratio, 2.63; 95% confidence interval, 1.02-6.82, adjusted for age, sex, smoking status, and time of blood sampling). The association remained significant, when including the baseline NIHSS, TIA, serum CRP, atrial fibrillation, body mass index, and total cholesterol as additional variables (odds ratio, 3.95; 95% confidence interval, 1.25-12.47), and was confirmed by the secondary outcome (Barthel Index: odds ratio, 9.12; 95% confidence interval, 2.08-39.89). Subclinical hyperthyroidism is a risk factor for poor outcome 3 months after ischemic stroke.

Changes of serum bone metabolic biochemical markers in elderly subjects with subclinical hypothyroidism

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Dai Yaozong; Li Liren

2005-01-01

Objective: To explore the clinical significance of changes of serum bone metabolic biochemical markers levels in elderly subjects with subclinical hypothyroidism. Methods: Serum S-BGP (with RIA), TSH, FT 4 (with ECLIA), total cholesterol (TC), triglyceride (TG), HDL, LDL, ApoA 1 , ApoB and Ca 2+ (with biochemical methods) were measured in 30 elderly subjects with subclinical hypothyroidism and 30 controls. Results: The serum levels of S-BGP and calcium in elderly subjects with subclinical hypothyroidism (2.78 ± 0.96 μg/L and 2.16 ± 0.17 mmol/L respectively) were significantly lower than those in controls (3.9 ± 1.48 μg/L and 2.31 ± 0.21 mmol/L respectively, both P<0.01). TC and LDL levels in the subclinical hypothyroid subjects (5.58 ± 0.41 mmol/L and 3.67 ± 0.36 mmol/L) were significantly higher than those in controls (P<0.01). Conclusion: The lowering of calcium levels in subjects with subclinical hypothyroidism would lead to loss of bone mass. Decreased S-BGP contents might be the chief cause of osteoporosis in these subjects. (authors)

Infrared reflectance as a diagnostic adjunct for subclinical commotio retinae

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Nicholas H Andrew

2014-01-01

Full Text Available Commotio retinae (CR is an outer retinal disorder following blunt trauma to the eye. Histologically it is characterized by disruption of the photoreceptor outer segments (OS, typically without injury to other retinal layers. Using spectral-domain optical coherence tomography (OCT the condition is visible as hyper-reflectivity of the OS. Most cases of CR are associated with transient grey-white discoloration of the retina and are easily diagnosed clinically, but there have been reports of OCT-confirmed CR without retinal discoloration. It is likely that this subclinical variant of CR is under-recognized as the OCT features of CR are subtle. Here, we report a case of OCT-confirmed subclinical CR that demonstrated prominent infrared hypo-reflectance, using the infrared protocol of the SPECTRALIS® OCT, Heidelberg Engineering. This case suggests that infrared reflectance may have a role in diagnosing cases of subclinical CR.

Evaluation of endothelial function in exogenous subclinical hyperthyroidism and the effect of treatment

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Sayed Mohammad Hosseini

2016-01-01

Conclusions: This study demonstrated that FMD decreased in exogenous subclinical hyperthyroid patients which could be partially restored by treatment. These findings suggest that treatment of subclinical hyperthyroid state could improve endothelial dysfunction and at the end decreased the cardiovascular complications.

Serum cytokine profile in the subclinical form of visceral leishmaniasis

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Gama M.E.A.

2004-01-01

Full Text Available The factors determining the development or not of visceral leishmaniasis (VL have not been completely identified, but a Leishmania-specific cellular immune response seems to play a fundamental role in the final control of infection. Few studies are available regarding the production of cytokines in the subclinical form of VL, with only the production of IFN-g and TNF-a known. The aim of the present study was to identify immunological markers for the oligosymptomatic or subclinical form of VL. A prospective cohort study was conducted on 784 children aged 0 to 5 years from an endemic area in the State of Maranhão, Brazil, between January 1998 and December 2001. During 30 consecutive months of follow-up, 33 children developed the oligosymptomatic form of the disease and 12 the acute form. During the clinical manifestations, serum cytokine levels were determined in 27 oligosymptomatic children and in nine patients with the acute form using a quantitative sandwich enzyme immunoassay. In the subclinical form of VL, variable levels of IL-2 were detected in 52.3% of the children, IL-12 in 85.2%, IFN-g in 48.1%, IL-10 in 88.9%, and TNF-a in 100.0%, with the last two cytokines showing significantly lower levels than in the acute form. IL-4 was not detected in oligosymptomatic individuals. Multiple discriminant analysis used to determine the profile or combination of cytokines predominating in the subclinical form revealed both a Leishmania resistance (Th1 and susceptibility (Th2 profile. The detection of both Th1 and Th2 cytokine profiles explains the self-limited evolution accompanied by the discrete alterations observed for the subclinical form of VL.

Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace.

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Diaz-Olmos, Rodrigo; Nogueira, Antônio-Carlos; Penalva, Daniele Queirós Fucciolo; Lotufo, Paulo Andrade; Benseñor, Isabela Martins

2010-01-01

Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP). All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH), free thyroxine (free-T4) and anti-thyroperoxidase antibodies (anti-TPO). The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01). There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l) did not change the results. In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

A stepwise approach to the evaluation and treatment of subclinical hyperthyroidism.

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Mai, Vinh Q; Burch, Henry B

2012-01-01

To review a stepwise approach to the evaluation and treatment of subclinical hyperthyroidism. English-language articles regarding clinical management of subclinical hyperthyroidism published between 2007 and 2012 were reviewed. Subclinical hyperthyroidism is encountered on a daily basis in clinical practice. When evaluating patients with a suppressed serum thyrotropin value, it is important to exclude other potential etiologies such as overt triiodothyronine toxicosis, drug effect, nonthyroidal illness, and central hypothyroidism. In younger patients with mild thyrotropin suppression, it is acceptable to perform testing again in 3 to 6 months to assess for persistence before performing further diagnostic testing. In older patients or patients with thyrotropin values less than 0.1 mIU/L, diagnostic testing should proceed without delay. Persistence of thyrotropin suppression is more typical of nodular thyroid autonomy, whereas thyroiditis and mild Graves disease frequently resolve spontaneously. The clinical consequences of subclinical hyperthyroidism, such as atrial dysrhythmia, accelerated bone loss, increased fracture rate, and higher rates of cardiovascular mortality, are dependent on age and severity. The decision to treat subclinical hyperthyroidism is directly tied to an assessment of the potential for clinical consequences in untreated disease. Definitive therapy is generally selected for patients with nodular autonomous function, whereas antithyroid drug therapy is more appropriate for mild, persistent Graves disease. The presented stepwise approach to the care of patients presenting with an isolated suppression of serum thyrotropin focuses on the differential diagnosis, a prediction of the likelihood of persistence, an assessment of potential risks posed to the patient, and, finally, a personalized choice of therapy.

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

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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

Stochastic modelling to evaluate the economic efficiency of treatment of chronic subclinical mastitis

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Steeneveld, W.; Hogeveen, H.; Borne, van den B.H.P.; Swinkels, J.M.

2006-01-01

Treatment of subclinical mastitis is traditionally no common practice. However, some veterinarians regard treatment of some types of subclinical mastitis to be effective. The goal of this research was to develop a stochastic Monte Carlo simulation model to support decisions around treatment of

Proteomics of inflammatory and oxidative stress response in cows with subclinical and clinical mastitis.

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Turk, Romana; Piras, Cristian; Kovačić, Mislav; Samardžija, Marko; Ahmed, Hany; De Canio, Michele; Urbani, Andrea; Meštrić, Zlata Flegar; Soggiu, Alessio; Bonizzi, Luigi; Roncada, Paola

2012-07-19

Cow serum proteome was evaluated by three different complementary approaches in the control group, subclinical and clinical mastitis in order to possibly find differential protein expression useful for a better understanding of the pathophysiology of mastitis as well as for an early diagnosis of the disease. The systemic inflammatory and oxidative stress response in cows with subclinical and clinical mastitis were observed. The collected evidence shows a differential protein expression of serpin A3-1, vitronectin-like protein and complement factor H in subclinical mastitis in comparison with the control. It was also found a differential protein expression of inter-alpha-trypsin inhibitor heavy chain H4, serpin A3-1, C4b-binding protein alpha chain, haptoglobin and apolipoprotein A-I in clinical mastitis compared to the control. Among the inflammatory proteins up-regulated in clinical mastitis, vitronectin is over-expressed in both subclinical and clinical mastitis indicating a strong bacterial infection. This suggests vitronectin as an important mediator in the pathogenesis of the onset of mastitis as well as a valuable marker for diagnosis of the subclinical form of the disease. Obtained data could be useful for the detection of mastitis during the subclinical phase and for a better comprehension of the pathophysiological mechanisms involved in the onset of the disease. Copyright © 2012 Elsevier B.V. All rights reserved.

Subclinical hypothyroidism in the first trimester of pregnancy in North India

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Jubbin Jagan Jacob

2013-01-01

Full Text Available Subclinical hypothyroidism based on population and trimester specific cut-offs is reported to complicate 1-2% of all pregnancies. Using the recent Endocrine Society guidelines of 2.5 mIU/L of Thyroid Stimulating Hormone as the upper level of normal in the first trimester the reported prevalence of subclinical hypothyroidism is much higher. Recent publications have also emphasized that there is considerable racial variation in the prevalence of thyroid disorders in pregnancy. Among published literature North Indian women appear to have the highest rates of subclinical hypothyroidism in the first trimester of pregnancy. More widespread use of universal screening and trimester specific ranges in pregnancy for thyroid hormonal assays will lead to a large number of North Indian women requiring treatment for thyroid disorders in pregnancy.

Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis.

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Itxaso González-Ortega

Full Text Available Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use.64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a patients with subclinical depressive symptoms at least once during follow-up (DPG, and (b patients without subclinical depressive symptoms during follow-up (NDPG. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS, depressive symptoms using the Hamilton Depression Rating Scale (HDRS-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF. A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome.Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001 and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009.Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

CT coronary angiography vs. invasive coronary angiography in CHD

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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

Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace

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Rodrigo Diaz-Olmos

Full Text Available CONTEXT AND OBJECTIVE: Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. DESIGN AND SETTING: Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP. METHODS: All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH, free thyroxine (free-T4 and anti-thyroperoxidase antibodies (anti-TPO. RESULTS: The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01. There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l did not change the results. CONCLUSION: In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study.

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Piero Ruscitti

Full Text Available Several studies showed the close relationship between Rheumatoid Arthritis (RA and cerebro-cardiovascular events (CVEs and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH, type 2 diabetes mellitus and metabolic syndrome (MS, at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.

Higher association of coronary artery calcification with non-alcoholic fatty liver disease than with abdominal obesity in middle-aged Korean men: the Kangbuk Samsung Health Study.

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Lee, Min-Kyung; Park, Hye-Jeong; Jeon, Won Seon; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

2015-07-15

It is uncertain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity is more associated with atherosclerosis. The aim of this study was to determine whether NAFLD or abdominal obesity is more strongly associated with subclinical atherosclerosis represented by coronary artery calcification (CAC). A total of 21,335 male participants in a health screening program (mean age 41 years) were enrolled. Ultrasonographic measurements of fatty liver and multi-detector computed tomography were performed to determine the coronary artery calcium score (CACS). The presence of CAC was defined as CACS > 0. Subjects were divided into four groups according to the presence or absence of NAFLD and/or abdominal obesity as assessed by waist-hip ratio (WHR) > 0.9. The presence of CAC was detected in 2,385 subjects (11.2%). The proportion of subjects with CAC was highest in the abdominal obesity only group (23.2%). After adjustment for age, diabetes history, hypertension, cigarette smoking, and physical inactivity, the odds ratio (OR) for CAC was the highest in the group with both abnormalities [1.465 (1.324-1.623)]. The NAFLD only group showed significantly increased OR for CAC compared to that in the abdominal obesity only group [1.286 (1.151-1.436) vs. 1.076 (0.939-1.233)]. Non-alcoholic fatty liver disease is more closely associated with CAC than abdominal obesity as assessed by the WHR. NAFLD could be considered an independent determinant of subclinical atherosclerosis as assessed by CAC.

Associations between retinol-binding protein 4 and cardiometabolic risk factors and subclinical atherosclerosis in recently postmenopausal women: cross-sectional analyses from the KEEPS study

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Huang Gary

2012-07-01

Full Text Available Abstract Background The published literature regarding the relationships between retinol-binding protein 4 (RBP4 and cardiometabolic risk factors and subclinical atherosclerosis is conflicting, likely due, in part, to limitations of frequently used RBP4 assays. Prior large studies have not utilized the gold-standard western blot analysis of RBP4 levels. Methods Full-length serum RBP4 levels were measured by western blot in 709 postmenopausal women screened for the Kronos Early Estrogen Prevention Study. Cross-sectional analyses related RBP4 levels to cardiometabolic risk factors, carotid artery intima-media thickness (CIMT, and coronary artery calcification (CAC. Results The mean age of women was 52.9 (± 2.6 years, and the median RBP4 level was 49.0 (interquartile range 36.9-61.5 μg/mL. Higher RBP4 levels were weakly associated with higher triglycerides (age, race, and smoking-adjusted partial Spearman correlation coefficient = 0.10; P = 0.01, but were unrelated to blood pressure, cholesterol, C-reactive protein, glucose, insulin, and CIMT levels (all partial Spearman correlation coefficients ≤0.06, P > 0.05. Results suggested a curvilinear association between RBP4 levels and CAC, with women in the bottom and upper quartiles of RBP4 having higher odds of CAC (odds ratio [95% confidence interval] 2.10 [1.07-4.09], 2.00 [1.02-3.92], 1.64 [0.82-3.27] for the 1st, 3rd, and 4th RBP4 quartiles vs. the 2nd quartile. However, a squared RBP4 term in regression modeling was non-significant (P = 0.10. Conclusions In these healthy, recently postmenopausal women, higher RBP4 levels were weakly associated with elevations in triglycerides and with CAC, but not with other risk factors or CIMT. These data using the gold standard of RBP4 methodology only weakly support the possibility that perturbations in RBP4 homeostasis may be an additional risk factor for subclinical coronary atherosclerosis. Trial registration ClinicalTrials.gov number NCT

Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

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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

BOVINE PLASMA FIBRINOGEN AS MARKER IN CLINICAL AND SUB-CLINICAL MASTITIS

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R. Ali

2018-06-01

Full Text Available Plasma samples were collected from healthy as well as clinical and sub-clinical mastitis affected cows from Barasat, West Bengal, India. Plasma samples, after ammonium sulphate precipitation, were dialyzed against several changes of PBS (pH 7.2 to remove the excess ammonium sulphate. Then plasma fibrinogens were purified by gel filtration chromatography on Sephacryl S-200 HR. SDS-PAGE (10% of purified fibrinogen from plasma of healthy cow revealed polypeptide bands of 74, 67 and 57 kDa which represent the α (alpha, β (beta and γ (gamma- chains respectively. On the other hand, purified fibrinogen from plasma of sub-clinical and clinical mastitis affected cow revealed polypeptide bands of 73 (α-chain, 68 kDa (β-chain and 72 (γ-chain, 68 kDa (β-chain respectively. The SDS-PAGE analysis showed the absence of gamma (γ- chain of fibrinogen in both the samples of sub-clinical and clinical mastitis positive cow. Single precipitin line was observed in double immunodiffusion test when purified fibrinogen from healthy, clinical and subclinical mastitis positive cows reacted with hyper immune sera raised in rabbit. No precipitin line was found against the normal control serum. These purified fibrinogens also showed cross reactivity against antibody raised in rabbit when analyzed by western blot technique.

Study on the incidence and etiology of subclinical thyroid function disorders

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Gu Jingxin; Xie Xiuhai; Huang Chenyang; Fu Junyan; Lu Weiguo; Chen Kejing

2006-01-01

Objective: To study the incidence and etiology of subclinical thyroid function disorders in 12592 subjects tested. Methods: The etiology of 874 patients with abnormal serum TSH (with IRMA) found in the tested 12592 patients, whose serum T 3 , T 4 , FT 3 , FT 4 , TSH, TGA and TMA were also detected with RIA was analyzed. Results: 874 of 12592 patients had abnormal TSH levels (6.94%). Among them, TSH was elevated in 397 patients (3.15%) and decreased in 477 patients (3.79%). Most of them were associated with obvious related thyroid or other thronic diseases such as hyperthyroidism after therapy, thyroxine replacement treatment of hypothyroidism and other thyroid diseases (thyroiditis, diffuse nontoxic goiter). In the remaining apparently disease-free 143 subjects, there were with subclinical hypothyroidism and 34 (3.89% of 874) with subclinical hyperthyroidism. Also among the 874 patients, 30.78% (n=269) patients had elevated TGA and TMA[16.82% (n=147) had elevated TSH and TGA, TMA simultaneously, 13.96% (n=122) had decreased TSH and elevated TGA and TMA simultaneously]. In the 874 patients, 256 (29.29%) were older than 60. Conclusion: Elderly people has higher incidence of subclinical thyroid function disorders. We should pay more attention to the detection of this condition, especially in elderly patients. (authors)

Subclinical laminitis and its association with pO2 and faecal alterations: Isikli, Aydin experience

OpenAIRE

Ibrahim Akin; Deniz Alic Ural; Mehmet Gultekin; Kerem Ural

2015-01-01

ABSTRACTObjective. The aim of this field trial was to investigate the relationships among subclinical laminitis, hematological, ruminal and faecal alterations. Materials and Methods. To this extent dairy cows presenting subclinical laminitis (n=11) and to those of other healthy cows without laminitis (n=10) were enrolled and assigned into two groups. All animals were receiving the same daily ration formulated to contain 47% cornsilage and 18% hay, mainly. Effects of subclinical laminitis chal...

The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

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Polovina Snežana

2015-01-01

Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

[POSSIBLE CAUSES OF INEFFICIENT MONOTHERAPY OF SUBCLINICAL HYPOTHYROIDISM WITH L-THYROXIN].

Science.gov (United States)

Budnevsky, A V; Kravchenko, A Ya; Drobysheva, E S; Fes'kova, A A

2015-01-01

Substitution therapy with L-thyroxin was recognized in 2012 to be the method of choice for the treatment of subclinical hypothyroidism. However it does not always allow to achieve normalization of all metabolic parameters. The aim of our work was to search for and analyze data on the possible mechanisms responsible for the failure of replacement hormonal therapy with L-thyroxin with a view to changing the therapeutic strategy for patients with subclinical hypothyroidism.

The Clinical Study on 39 Cases of Subclinical Hypothyroidism

International Nuclear Information System (INIS)

Yu, Cheol Jae; Ahn, Weon Jeon; Lee, Houn Young; Ro, Heung Kyu

1986-01-01

Subclinical hypothyroidism can be defined as an asymptomatic state in which a reduction in thyroid activity has been compensated by an increased TSH output to maintain an euthyroid state. We analysed clinical features, laboratory data, and pathologic findings in 39 cases of subclinical hypothyroidism who were diagnosed at the Dept. of Internal Medicine, Chungnam National University Hospital from Aug. 1984 to June, 1985. 1) The age distribution was from sixteen to sixty-nine and mean age was 34.8. Peak incidence was in the 4th decade and 3rd, 5th, 6th decade in order. 2) The sex distribution showed female preponderance with a ratio of 18.5 to 1. 3) The major presenting manifestations were nonspecific ones such as fatigue, indigestion, and anorexia. 4) Physical examination revealed diffuse goiter in 47.6%. Major abnormalities were no gross abnormality (30.9%), nodular goiter and facial edema. 5) There was no significant difference of the basal serum T3 and T4 concentrations between subclinical hypothyroidism and normal controls (p>0.05). 6) The basal serum TSH concentration of subclinical hypothyroidism (32.61±14.95 μU/ml) was significantly higher than that of normal controls (3.92±1.05 μU/ml) (p<0.005). 7) Microsomal antibody was detected in 80.6% and thyroglobulin antibody was detected in 30%. 8) The pathologic findings in 26 cases revealed Hashimoto's thyroiditis in 76.9% (lymphocytic type, 34.6%; oxyphilic type, 26.9%; fibrotic type, 15.4%). The others were adenomatous goiter (15.4%), adenomatous carcinoma (3.8%) and subacute thyroiditis (3.8%).

The Clinical Study on 39 Cases of Subclinical Hypothyroidism

Energy Technology Data Exchange (ETDEWEB)

Yu, Cheol Jae; Ahn, Weon Jeon; Lee, Houn Young; Ro, Heung Kyu [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

1986-03-15

Subclinical hypothyroidism can be defined as an asymptomatic state in which a reduction in thyroid activity has been compensated by an increased TSH output to maintain an euthyroid state. We analysed clinical features, laboratory data, and pathologic findings in 39 cases of subclinical hypothyroidism who were diagnosed at the Dept. of Internal Medicine, Chungnam National University Hospital from Aug. 1984 to June, 1985. 1) The age distribution was from sixteen to sixty-nine and mean age was 34.8. Peak incidence was in the 4th decade and 3rd, 5th, 6th decade in order. 2) The sex distribution showed female preponderance with a ratio of 18.5 to 1. 3) The major presenting manifestations were nonspecific ones such as fatigue, indigestion, and anorexia. 4) Physical examination revealed diffuse goiter in 47.6%. Major abnormalities were no gross abnormality (30.9%), nodular goiter and facial edema. 5) There was no significant difference of the basal serum T3 and T4 concentrations between subclinical hypothyroidism and normal controls (p>0.05). 6) The basal serum TSH concentration of subclinical hypothyroidism (32.61+-14.95 muU/ml) was significantly higher than that of normal controls (3.92+-1.05 muU/ml) (p<0.005). 7) Microsomal antibody was detected in 80.6% and thyroglobulin antibody was detected in 30%. 8) The pathologic findings in 26 cases revealed Hashimoto's thyroiditis in 76.9% (lymphocytic type, 34.6%; oxyphilic type, 26.9%; fibrotic type, 15.4%). The others were adenomatous goiter (15.4%), adenomatous carcinoma (3.8%) and subacute thyroiditis (3.8%).

Regression of the increased common carotid artery-intima media thickness in subclinical hypothyroidism after thyroid hormone replacement.

Science.gov (United States)

Kim, Soo-Kyung; Kim, Se-Hwa; Park, Kyung-Sun; Park, Seok-Won; Cho, Yong-Wook

2009-01-01

The association between subclinical hypothyroidism and cardiovascular disease and the beneficial effect of levothyroxine replacement in subclinical hypothyroidism are still under debate. The present study was designed to determine whether subclinical hypothyroidism is associated with an increase in the intima-media thickness of the common carotid artery (C-IMT) and whether thyroid hormone replacement can reverse this change in the C-IMT. Patients with newly-diagnosed subclinical (n=36) and overt (n=40) hypothyroidism and healthy euthyroid individuals (n=32) participated in this study. All the patients were examined for clinical characteristics, and the serum lipid levels and the C-IMT were measured. Patients with subclinical hypothyroidism had a C-IMT measurement after 18 months of levothyroxine replacement. There were meaningful differences in total cholesterol and LDL-cholesterol levels between patients with subclinical hypothyroidism and euthyroidism. The subjects with subclinical and overt hypothyroidism had a greater C-IMT compared with euthyroid controls (0.66+/- 0.10 and 0.70+/- 0.11 vs. 0.57+/- 0.08 mm, respectively; P replacement significantly decreased the C-IMT (0.67+/- 0.11 to 0.60+/- 0.10 mm; P = 0.021) and improved the lipid profile. Based on multiple regression analysis, the decrement in LDL-cholesterol was independently associated with the regression of the C-IMT. Subclinical hypothyroidism was closely related to an increased C-IMT. Thyroid hormone replacement resulted in regression of the increased C-IMT, which was attributed to the improvement in the lipid profile.

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

DEFF Research Database (Denmark)

Faber, J; Wiinberg, N; Schifter, S

2001-01-01

Hyperthyroidism has profound effects on the cardiovascular system, including reduced systemic vascular resistance (SVR) due to relaxation of vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart...... rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T4) and tri-iodothyronine (T3) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography......) in subjects with endogenous subclinical hyperthyroidism in order to elucidate whether these patients had signs of excess thyroid hormone at the tissue level....

Is subclinical hypothyroidism increasing exogen obesity in children?

Directory of Open Access Journals (Sweden)

Ceyda Tuna Kirsaclioglu

2015-03-01

Conclusion:.Thyrotropin releasing hormone stimulation test may be helpful to determine subclinical hypothyroidism in exogen obese children, if basal TSH levels were elevated. [J Contemp Med 2015; 5(1.000: 1-7

Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.

Science.gov (United States)

Goldberg, Ronald B; Aroda, Vanita R; Bluemke, David A; Barrett-Connor, Elizabeth; Budoff, Matthew; Crandall, Jill P; Dabelea, Dana; Horton, Edward S; Mather, Kieren J; Orchard, Trevor J; Schade, David; Watson, Karol; Temprosa, Marinella

2017-07-04

Despite the reduced incidence of coronary heart disease with intensive risk factor management, people with diabetes mellitus and prediabetes remain at increased coronary heart disease risk. Diabetes prevention interventions may be needed to reduce coronary heart disease risk. This approach was examined in the DPP (Diabetes Prevention Program) and the DPPOS (Diabetes Prevention Program Outcome Study), a long-term intervention study in 3234 subjects with prediabetes (mean±SD age, 64±10 years) that showed reduced diabetes risk with lifestyle and metformin compared with placebo over 3.2 years. The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants with coronary artery calcium (CAC) measurements after an average of 14 years of follow-up. The CAC scores were analyzed continuously as CAC severity and categorically as CAC presence (CAC score >0) and reported separately in men and women. There were no CAC differences between lifestyle and placebo intervention groups in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity, 39.5 versus 66.9 Agatston units, P =0.04; CAC presence, 75% versus 84%, P =0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric, or metabolic factors; by the development of diabetes mellitus; or by use/nonuse of statin therapy. Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes mellitus among men. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00038727. © 2017 American Heart Association, Inc.

Association between diabetic retinopathy and subclinical atherosclerosis in China: Results from a community-based study.

Science.gov (United States)

Liu, Yu; Teng, Xiangyu; Zhang, Wei; Zhang, Ruifeng; Liu, Wei

2015-09-01

To evaluate the association of diabetic retinopathy with subclinical atherosclerosis in middle-aged and elderly Chinese with type 2 diabetes. A cross-sectional community-based study was performed among 1607 patients aged 40 years or older in Shanghai. Non-mydriatic digital fundus photography examination was used in diabetic retinopathy detection. Presence of elevated carotid intima-media thickness or carotid plaque was defined as subclinical atherosclerosis. The prevalence of diabetic retinopathy was 15.1% in total patients. Patients with diabetic retinopathy were more likely to have elevated carotid intima-media thickness, carotid plaque and subclinical atherosclerosis than those without diabetic retinopathy (37.9% vs 30.7%, 57.6% vs 49.6% and 64.6% vs 57.1%, respectively). The presence of diabetic retinopathy was significantly associated with increased odds of subclinical atherosclerosis (odds ratio = 1.93, 95% confidence interval = 1.03-3.60) after full adjustments. The presence of diabetic retinopathy was significantly associated with subclinical atherosclerosis in middle-aged and elderly patients with type 2 diabetics in China. © The Author(s) 2015.

Associations of serum LDL particle concentration with carotid intima-media thickness and coronary artery calcification.

Science.gov (United States)

Zaid, Maryam; Miura, Katsuyuki; Fujiyoshi, Akira; Abbott, Robert D; Hisamatsu, Takashi; Kadota, Aya; Arima, Hisatomi; Kadowaki, Sayaka; Torii, Sayuki; Miyagawa, Naoko; Suzuki, Sentaro; Takashima, Naoyuki; Ohkubo, Takayoshi; Sekikawa, Akira; Maegawa, Hiroshi; Horie, Minoru; Nakamura, Yasuyuki; Okamura, Tomonori; Ueshima, Hirotsugu

2016-01-01

Low-density lipoprotein particle (LDL-P) has recently been found to be a stronger predictor of cardiovascular disease (CVD) than LDL-cholesterol (LDL-C). Whether LDL-P is associated with subclinical atherosclerosis, independent of LDL-C, as well as other lipid measures has not been fully examined. We aimed to analyze LDL-P associations with measures of subclinical atherosclerosis. We examined 870 Japanese men randomly selected from Kusatsu City, Shiga, Japan, aged 40-79 years from 2006-2008, free of clinical CVD and not using lipid-lowering medication. Cross-sectional associations of lipid measures with carotid intima-media thickness (cIMT) and coronary artery calcification (CAC; >0 Agatston score) were examined. LDL-P was significantly positively associated with cIMT and maintained this association after adjustments for LDL-C and other lipid measures. Although these lipid measures were positively associated with cIMT, model adjustment for LDL-P removed any significant relationships. Higher LDL-P was associated with a significantly higher odds ratio of CAC and further adjustment for LDL-C did not affect this relationship. In contrast, the LDL-C association with CAC was no longer significant after adjustment for LDL-P. Other lipid measures attenuated associations of LDL-P with CAC. Likewise, associations of these measures with CAC were attenuated when model adjustments for LDL-P were made. In a community-based sample of Japanese men, free of clinical CVD, LDL-P was a robust marker for subclinical atherosclerosis, independent of LDL-C and other lipid measures. Associations of LDL-C and other lipid measures with either cIMT or CAC were generally not independent of LDL-P. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Relationship between beta lactoglobulin and subclinical mastitis in Valle del Belice sheep breed

NARCIS (Netherlands)

Gigli, I.; Riggio, V.; Monteleone, G.; Cacioppo, D.; Rosa, A.J.M.; Maizon, D.O.

2007-01-01

The objective of the following research was to determine the effect of LGB genotypes on subclinical mastitis in Valle del Belice dairy sheep. Ewes were classified as affected or not by subclinical mastitis within a lactation based on i) a positive culture in one of the test-days and ii) more than

Subclinical avian influenza A(H5N1) virus infection in human, Vietnam

NARCIS (Netherlands)

Le, Mai Quynh; Horby, Peter; Fox, Annette; Nguyen, Hien Tran; Le Nguyen, Hang Khanh; Hoang, Phuong Mai Vu; Nguyen, Khanh Cong; de Jong, Menno D.; Jeeninga, Rienk E.; Rogier van Doorn, H.; Farrar, Jeremy; Wertheim, Heiman F. L.

2013-01-01

Laboratory-confirmed cases of subclinical infection with avian influenza A(H5N1) virus in humans are rare, and the true number of these cases is unknown. We describe the identification of a laboratory-confirmed subclinical case in a woman during an influenza A(H5N1) contact investigation in northern

Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study.

Science.gov (United States)

Andrade, Gustavo R G; Gorgulho, Bartira; Lotufo, Paulo A; Bensenor, Isabela M; Marchioni, Dirce M

2018-05-30

Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years. Dietary data was collected using a previously validated food frequency questionnaire. Subclinical hypothyroidism was categorized as thyroid-stimulating hormone levels of >4.0 IU/mL and free prohormone thyroxine levels within normal limits, without administering drugs for thyroid disease. A multiple logistic regression model was used to assess the relationship between the presence of subclinical hypothyroidism and tertiles of Se consumption. The prevalence of subclinical hypothyroidism in the study sample was 5.4% (95% confidence interval [CI], 3.8⁻7.0%). Compared with the first tertile of Se intake, the second (odds ratio [OR], 0.79; 95% CI, 0.65⁻0.96%) and third (OR, 0.72; 95% CI, 0.58⁻0.90%) tertiles were inversely associated with subclinical hypothyroidism, however further research is needed to confirm the involvement of Se in subclinical hypothyroidism using more accurate methodologies of dietary assessment and nutritional status to evaluate this relationship.

Long-term outcome in levothyroxine treated patients with subclinical hypothyroidism and concomitant heart disease

DEFF Research Database (Denmark)

Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager

2016-01-01

Context: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function. Objective: This study sought to examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease. Design: This was a register-based historical cohort s...

Arterial wave reflection and subclinical left ventricular systolic dysfunction.

Science.gov (United States)

Russo, Cesare; Jin, Zhezhen; Takei, Yasuyoshi; Hasegawa, Takuya; Koshaka, Shun; Palmieri, Vittorio; Elkind, Mitchell Sv; Homma, Shunichi; Sacco, Ralph L; Di Tullio, Marco R

2011-03-01

Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left-ventricular (LV) systolic function in individuals without heart failure is not clear. Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using two-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by LV ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF less than 50% or wall motion abnormalities were excluded. Mean age of the study population was 68.3 ± 10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (P values from 0.05 to 0.002). In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship.

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

Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus

Energy Technology Data Exchange (ETDEWEB)

Schillaci, O. [Nuclear Medicine, University of l`Aquila (Italy); Lagana, B.; Gentile, R.; Tubani, L.; Baratta, L. [Department of Clinical Medicine, University ``La Sapienza``, Rome (Italy); Danieli, R.; Scopinaro, F. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy)

1999-07-01

In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with {sup 99m}Tc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images (``reverse redistribution pattern``). Coronary angiography was performed in eight patients with positive {sup 99m}Tc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that {sup 99m}Tc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole {sup 99m}Tc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events. (orig.) With 2 figs., 2 tabs., 21 refs.

Technetium-99m sestamibi single-photon emission tomography detects subclinical myocardial perfusion abnormalities in patients with systemic lupus erythematosus

International Nuclear Information System (INIS)

Schillaci, O.; Lagana, B.; Gentile, R.; Tubani, L.; Baratta, L.; Danieli, R.; Scopinaro, F.

1999-01-01

In patients with systemic lupus erythematosus, involvement of the cardiovascular system is the third leading cause of death. However, although autopsy studies have demonstrated a high incidence of abnormalities in both the myocardium and coronary vessels, clinical manifestations have been reported in only a small percentage of cases. The aim of this study was to evaluate myocardial perfusion in asymptomatic lupus patients using technetium-99m sestamibi single-photon emission tomography (SPET). Twenty-eight patients without overt cardiac involvement and risk factors were studied with 99m Tc-sestamibi SPET at rest and after dipyridamole infusion. Perfusion abnormalities were detected in 18 cases: six had persistent defects, three had reversible defects, seven had both persistent and reversible defects, and two showed rest defects which normalized on dipyridamole images (''reverse redistribution pattern''). Coronary angiography was performed in eight patients with positive 99m Tc-sestamibi SPET, and showed normal epicardial vessels in all the cases. These results indicate that 99m Tc-sestamibi SPET reveals a high prevalence (18 out of 28 patients in this study, i.e. 64%) of myocardial perfusion abnormalities in asymptomatic lupus patients, probably due to the primary immunological damage of this autoimmune disease. In conclusion, rest/dipyridamole 99m Tc-sestamibi SPET can be a useful non-invasive method to identify subclinical myocardial involvement in systemic lupus erythematosus, and patients potentially at risk of later cardiac events. (orig.)

Subclinical hypothyroidism in childhood.

LENUS (Irish Health Repository)

O'Grady, M J

2012-02-01

Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) in association with a normal total or free thyroxine (T4) or triiodothyronine (T3). It is frequently encountered in both neonatology and general paediatric practice; however, its clinical significance is widely debated. Currently there is no broad consensus on the investigation and treatment of these patients; specifically who to treat and what cut-off level of TSH should be used. This paper reviews the available evidence regarding investigation, treatments and outcomes reported for childhood SH.

Lipids in newly discovered subclinical and clinical hypothyroidism

Directory of Open Access Journals (Sweden)

Marinković Snežana

2016-01-01

Full Text Available There is a positive correlation between the levels of TSH and cholesterol levels, while levels between TSH levels triglicrerida negative correlation with the clinical and subclinical form of reduced thyroid function.

Multiple Determinations of Sperm DNA Fragmentation Show That Varicocelectomy Is Not Indicated for Infertile Patients with Subclinical Varicocele

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Agustín García-Peiró

2014-01-01

Full Text Available Varicocele is one of the most common causes of low semen quality, which is reflected in high percentages of sperm cells with fragmented DNA. While varicocelectomy is usually performed to ameliorate a patient’s fertility, its impact on sperm DNA integrity in the case of subclinical varicocele is poorly documented. In this study, multiple DNA fragmentation analyses (TUNEL, SCD, and SCSA were performed on semen samples from sixty infertile patients with varicocele (15 clinical varicoceles, 19 clinical varicoceles after surgical treatment, 16 subclinical varicoceles, and 10 subclinical varicoceles after surgical treatment. TUNEL, SCD, and SCSA assays all showed substantial sperm DNA fragmentation levels that were comparable between subclinical and clinical varicocele patients. Importantly, varicocelectomy did improve sperm quality in patients with clinical varicocele; however, this was not the case in patients with subclinical varicocele. In summary, although infertile patients with clinical and subclinical varicocele have similar sperm DNA quality, varicocelectomy should only be advised for patients with clinical varicocele.

Assessment of thyroid hormones, insulin and magnesium in dairy cattle with subclinical ketosis

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A Sadeghi-nasab

2011-08-01

Full Text Available Ketosis, with ethologically energy deficiency, is one of the commonest metabolic diseases of dairy cattle. Assessment of some serum hormonal and metabolic status can be beneficent in prediction and diagnosis of subclinical ketosis. This study is performed for evaluation and comparison of thyroid hormones, insulin and magnesium of subclinical ketosis and healthy cows. During 60 days in milk (DIM serum Beta hydroxy butyric acid (BHBA and glucose levels of 200 dairy cattle have been measured. Based on 1.4 mmol/l of BHBA as a cut of point experimented animals separated to subclinical and healthy groups. Mean values of serum T3 and T4 of affected cows were significantly higher than non-affected (p

HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

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Vijayamma K. N

2018-01-01

Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

Science.gov (United States)

Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

2013-04-01

Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

Hypokalaemic Periodic Paralysis in a Patient with Subclinical Hyperthyroidism: A Rare Case

OpenAIRE

Hegde, Swati; Shaikh, Mohammed Aslam; Gummadi, Thejaswi

2016-01-01

Thyrotoxic Periodic Paralysis (TPP) is an uncommon disorder. Though many cases of hypokalaemic periodic paralysis are reported in overt hyperthyroidism, hypokalaemic paralysis in subclinical hyperthyroidism is very rare. Subclinical hyperthyroidism is characterised by circulating TSH levels below reference range and normal thyroid hormone levels. We describe a case of 32-year-old Asian male who presented to the emergency department with acute onset weakness and hypokalaemia with no previous h...

Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.

Science.gov (United States)

Lerman, Joseph B; Joshi, Aditya A; Chaturvedi, Abhishek; Aberra, Tsion M; Dey, Amit K; Rodante, Justin A; Salahuddin, Taufiq; Chung, Jonathan H; Rana, Anshuma; Teague, Heather L; Wu, Jashin J; Playford, Martin P; Lockshin, Benjamin A; Chen, Marcus Y; Sandfort, Veit; Bluemke, David A; Mehta, Nehal N

2017-07-18

Psoriasis, a chronic inflammatory disease associated with an accelerated risk of myocardial infarction, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease burden composed of noncalcified plaques with high-risk features. However, inadequate efforts have been made to directly measure coronary artery disease in this vulnerable population. As such, we sought to compare total coronary plaque burden and noncalcified coronary plaque burden (NCB) and high-risk plaque (HRP) prevalence between patients with psoriasis (n=105), patients with hyperlipidemia eligible for statin therapy under National Cholesterol Education Program-Adult Treatment Panel III guidelines (n=100) who were ≈10 years older, and healthy volunteers without psoriasis (n=25). Patients underwent coronary computed-tomography angiography for total coronary plaque burden and NCB quantification and HRP identification, defined as low attenuation (1.10), and spotty calcification. A consecutive sample of the first 50 patients with psoriasis was scanned again 1 year after therapy. Despite being younger and at lower traditional risk than patients with hyperlipidemia, patients with psoriasis had increased NCB (mean±SD: 1.18±0.33 versus 1.11±0.32, P =0.02) and similar HRP prevalence ( P =0.58). Furthermore, compared to healthy volunteers, patients with psoriasis had increased total coronary plaque burden (1.22±0.31 versus 1.04±0.22, P =0.001), NCB (1.18±0.33 versus 1.03±0.21, P =0.004), and HRP prevalence beyond traditional risk (odds ratio, 6.0; 95% confidence interval, 1.1-31.7; P =0.03). Last, among patients with psoriasis followed for 1 year, improvement in psoriasis severity was associated with improvement in total coronary plaque burden (β=0.45, 0.23-0.67; P psoriasis had greater NCB and increased HRP prevalence than

Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves

DEFF Research Database (Denmark)

Chakravarty, Tarun; Søndergaard, Lars; Friedman, John

2017-01-01

rates of transient ischaemic attacks (TIAs; 4·18 TIAs per 100 person-years vs 0·60 TIAs per 100 person-years; p=0·0005) and all strokes or TIAs (7·85 vs 2·36 per 100 person-years; p=0·001). INTERPRETATION: Subclinical leaflet thrombosis occurred frequently in bioprosthetic aortic valves, more commonly...... outcomes after TAVR with the new-generation valves, prevention and treatment of subclinical leaflet thrombosis might offer a potential opportunity for further improvement in valve haemodynamics and clinical outcomes. FUNDING: RESOLVE (Cedars-Sinai Heart Institute) and SAVORY (Rigshospitalet)....

Nerve ultrasound shows subclinical peripheral nerve involvement in neurofibromatosis type 2.

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Telleman, Johan A; Stellingwerff, Menno D; Brekelmans, Geert J; Visser, Leo H

2018-02-01

Neurofibromatosis type 2 (NF2) is mainly associated with central nervous system (CNS) tumors. Peripheral nerve involvement is described in symptomatic patients, but evidence of subclinical peripheral nerve involvement is scarce. We conducted a cross-sectional pilot study in 2 asymptomatic and 3 minimally symptomatic patients with NF2 to detect subclinical peripheral nerve involvement. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS). A total of 30 schwannomas were found, divided over 20 nerve segments (33.9% of all investigated nerve segments). All patients had at least 1 schwannoma. Schwannomas were identified with HRUS in 37% of clinically unaffected nerve segments and 50% of nerve segments with normal NCS findings. HRUS shows frequent subclinical peripheral nerve involvement in NF2. Clinicians should consider peripheral nerve involvement as a cause of weakness and sensory loss in the extremities in patients with this disease. Muscle Nerve 57: 312-316, 2018. © 2017 Wiley Periodicals, Inc.

The Natural History of Subclinical Hypothyroidism in the Elderly: The Cardiovascular Health Study

Science.gov (United States)

Somwaru, Lily L.; Rariy, Chevon M.; Arnold, Alice M.

2012-01-01

Context: Studies of long-term outcomes of subclinical hypothyroidism have assessed only baseline thyroid function, despite natural transitions to euthyroidism and overt hypothyroidism over time. Objective: We provide estimates of persistence, resolution, and progression of subclinical hypothyroidism over 4 yr, stratified by baseline TSH, anti-thyroid peroxidase antibody (TPOAb) status, age, and sex. Design, Setting, and Participants: Participants were 3996 U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study. Subclinical hypothyroidism was detected at baseline in 459 individuals not taking thyroid medication. Main Outcome Measure: Thyroid function was evaluated at 2 and 4 yr and initiation of thyroid medication annually. Results were stratified by baseline TSH, TPOAb status, age, and sex. Results: Persistence of subclinical hypothyroidism was 56% at 2 and 4 yr. At 2 yr, resolution was more common with a TSH of 4.5–6.9 mU/liter (46 vs. 10% with TSH 7–9.9 mU/liter and 7% with TSH ≥10 mU/liter; P hypothyroidism (P hypothyroidism were common between 2 and 4 yr. Age and sex did not affect transitions. Conclusions: Subclinical hypothyroidism persists for 4 yr in just over half of older individuals, with high rates of reversion to euthyroidism in individuals with lower TSH concentrations and TPOAb negativity. Future studies should examine the impact of transitions in thyroid status on clinical outcomes. PMID:22438233

Coronary blood flow and coronary stenosis correlations in ischemic heart patients

International Nuclear Information System (INIS)

Manukov, I.

2003-01-01

The aim of the study is the assessment of the methodology for the C-TIMI frame count by Gibson for easy and fast determination of the coronary blood flow during a selective coronary angiography. 75 patient have been studied with one-branch affection of the coronary arteries. The criteria for exclusion are: myocardial hypertrophy, valve lesions, myocardial infarction and dyslipidemia. Depending of the characteristics of the coronary stenotic changes, the patients have been divided into two groups: 1) Patients with 'ordinary' stenosis of the coronary artery and 2) Patients with 'complex' stenosis. The severity of the stenotic changes in percents is the same for the two groups - 78%±13% vs 81±12%, respectively. In the first group a pronounced correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. The 'threshold' stenotic level is 89%. In the second group the lowest value of the coronary stenosis is 73% (p>0.01 vs group 1). No correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. A conclusion is made that the Gibson method for the assessment of the blood flow is convenient for the daily practice not only for the assessment of the significance of the coronary changes, but also for fast analysis of the achieved reconstruction of the coronary arteries after angioplasty. Additional studies of the significance of the different signs of 'complexity' of the coronary stenosis for the slowing of the blood flow are necessary

Autonomic nervous system function in chronic exogenous subclinical thyrotoxicosis and the effect of restoring euthyroidism

NARCIS (Netherlands)

Eustatia-Rutten, Carmen F. A.; Corssmit, Eleonora P. M.; Heemstra, Karen A.; Smit, Johannes W. A.; Schoemaker, Rik C.; Romijn, Johannes A.; Burggraaf, Jacobus

2008-01-01

Knowledge on the relationship between the autonomic nervous system and subclinical hyperthyroidism is mainly based upon cross-sectional studies in heterogeneous patient populations, and the effect of restoration to euthyroidism in subclinical hyperthyroidism has not been studied. We investigated the

Significance of radionucleid examination of joints in diagnosis of subclinical arthritis background

International Nuclear Information System (INIS)

Andersone, D.; Bulina, I.

2005-01-01

Background. A large group of inflammation arthritis is represented by seronegative spondyloarthropathies (SpA), including several nosologies: psoriatic arthritis Bechterev's disease, Reiter's disease, etc. One of the most common SpA forms is Reactive arthritis (ReA). Inflammation process in joints is the most characteristic symptom, which determines severeness, course and prognosis of the disease. One of the most sensitive methods of examination of joints is radionucleid (RN) examination. Increased RNV accumulation in the joints is not a specific feature .for a concrete disease, and growth of its accumulation corresponds to the exudative component of inflammation process which reveals the early stage of joint inflammation (subclinical arthritis). Objectives: To find out how often subclinical inflammation processes (subclinical sinovitis) are observed in patients with minimal systemic activity of ReA. To detect in which joints subclinical sinovitis localizes most commonly. To evaluate significance of radionucleid examinations in diagnosis of subclinical arthritis. Material and methods. RN examination of joints was performed in 41 patient with ReA in I stage of activity and in 35 patients with ReA in II stage of activity, when the causative agent of infection - Chlamydia trachomatis - is localized in the urogenital tract. ReA was diagnosed according to diagnostic criteria of French Rheumatologists Association. For clinical description of joints index was used, characterized by pain intensity during joint palpation, and expressed by gradation degree from 0-3. In 76 patients with ReA I activity degree (ReA I) and ReA II activity degree (ReA II) radionucleid examination was done with marked 99 Tc and analysis of the obtained joint scintigrams for SI area. In the control group, 90 joint scintigrams were analyzed for patients with degenerative joint diseases without palpation pain in the examined joints, determining Tc index (Tc ind) in separate joints and summary Tc ind

Subclinical hyperthyroidism and sudden unexpected death in epilepsy.

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Scorza, Fulvio A; Arida, Ricardo M; Cysneiros, Roberta M; Terra, Vera C; de Albuquerque, Marly; Machado, Hélio R; Cavalheiro, Esper A

2010-04-01

Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. In parallel, several studies have shown a link between hormones and epilepsy. However, exact knowledge regarding the association of thyroid hormones and epilepsy is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease, we propose in this paper that SUDEP, at least in some cases, could be related with subclinical thyroid dysfunction. (c) 2009 Elsevier Ltd. All rights reserved.

A functionally significant polymorphism in ID3 is associated with human coronary pathology.

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Ani Manichaikul

Full Text Available We previously identified association between the ID3 SNP rs11574 and carotid intima-media thickness in the Diabetes Heart Study, a predominantly White diabetic population. The nonsynonymous SNP rs11574 results in an amino acid substitution in the C-terminal region of ID3, attenuating the dominant negative function of ID3 as an inhibitor of basic HLH factor E12-mediated transcription. In the current investigation, we characterize the association between the functionally significant polymorphism in ID3, rs11574, with human coronary pathology.The Multi-Ethnic Study of Atherosclerosis (MESA is a longitudinal study of subclinical cardiovascular disease, including non-Hispanic White (n = 2,588, African American (n = 2,560 and Hispanic (n = 2,130 participants with data on coronary artery calcium (CAC. The Coronary Assessment in Virginia cohort (CAVA included 71 patients aged 30-80 years, undergoing a medically necessary cardiac catheterization and intravascular ultrasound (IVUS at the University of Virginia. ID3 SNP rs11574 risk allele was associated with the presence of CAC in MESA Whites (P = 0.017. In addition, the risk allele was associated with greater atheroma burden and stenosis in the CAVA cohort (P = 0.003, P = 0.04 respectively. The risk allele remained predictive of atheroma burden in multivariate analysis (Model 1: covariates age, gender, and LDL, regression coefficient = 9.578, SE = 3.657, p = 0.0110; Model 2: covariates Model 1, presence of hypertension, presence of diabetes, regression coefficient = 8.389, SE = 4.788, p = 0.0163.We present additional cohorts that demonstrate association of ID3 SNP rs11574 directly with human coronary artery pathology as measured by CAC and IVUS: one a multiethnic, relatively healthy population with low levels of diabetes and the second a predominantly White population with a higher incidence of T2DM referred for cardiac catheterization.

[Developments in percutaneous coronary intervention and coronary stents].

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Simsek, C; Daemen, J; Zijlstra, F

2014-01-01

In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

Subclinical Hypothyroidism in Children and Adolescents: a single-center retrospective study

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Ana Margarida Monteiro

2018-04-01

Conclusion: The mild form of subclinical hypothyroidism was the most common typepf disease and, among patients managed conservatively, the majority presented normal thyroid function after one year of follow-up and none progressed to overt hypothyroidism. Our results reinforce the idea that, in most patients, subclinical hypothyroidism is a benign condition with a low risk of progression to overt thyroid dysfunction. However, further studies are needed to evaluate the potential long-term effects of the condition in untreated patients and to clarify the best clinical approach and follow-up strategy.

Should we treat mild subclinical/mild hyperthyroidism? Yes

NARCIS (Netherlands)

Wiersinga, Wilmar M.

2011-01-01

Whether or not subclinical hyperthyroidism (SCH) should be treated, remains a matter of debate because there are no randomized clinical trials answering the question if treatment improves long-term health outcomes. Cross-sectional and longitudinal population-based sudies demonstrate clear

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.

Hemostasis in Overt and Subclinical Hyperthyroidism

OpenAIRE

Ordookhani, Arash; Burman, Kenneth D.

2017-01-01

Context There are contradictory results on the effect of hyperthyroidism on hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). The present review focuses on hemostatic changes in overt and subclinical hyperthyroidism. Methods A systematic literature search was conducted employing MEDLINE database. The following words were used for the search: Hyperthyroidism; thyrotoxicosis; Graves disease; goiter, nodular; ...

Prevalence of subclinical hypothyroidism in adults visiting primary health-care setting in Riyadh.

Science.gov (United States)

Al Eidan, Eidan; Ur Rahman, Saeed; Al Qahtani, Saeed; Al Farhan, Ali I; Abdulmajeed, Imad

2018-01-01

Background and objectives : Subclinical hypothyroidism is an asymptomatic condition with normal thyroxin and raised thyroid stimulating hormone (TSH) level. The objective of the study was to determine the prevalence of subclinical hypothyroidism in primary health care (PHC) settings in Riyadh and explore the relationship of TSH level with age, gender, family history, body mass index, and co-morbid conditions. Subjects and methods : A cross-sectional study of adult visitors to nine satellites PHC clinics in military housing in Riyadh was carried out. TSH concentration and free T4 levels were measured. Data were collected by nurses and physicians during routine clinical practice in primary care. Descriptive analysis was performed on all variables in study, and relationships were explored using chi-square, t -test, analysis of variance, and linear regression. Results : A total of 340 out of 394 participants in the study gave blood samples. Subclinical hyperthyroidism was identified in 2.1% ( p  = .001) and subclinical hypothyroidism in 10.3% ( p  = .001) of the PHC visitors. TSH levels were found to be significantly higher ( p  = .047) in elderly population of ≥60 years and those with family history of thyroid disease. Non-significant upward trends were noted in TSH levels with hyperlipidemia and increasing blood pressure. No overt hyperthyroidism or hypothyroidism was found in our study sample. Conclusion : Subclinical hypothyroidism has a prevalence of 10% of adults visiting PHC's. TSH levels are higher in the elderly, which warrants screening of those aged 60 years and above.

Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

OpenAIRE

Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

2012-01-01

Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

Platysmal myoclonus in subclinical hyperthyroidism.

Science.gov (United States)

Teoh, Hock-Luen; Lim, Erle Chuen-Hian

2005-08-01

Hyperthyroidism is associated with various movement disorders, such as chorea and tremors. We report on a young Chinese woman with an unusual presentation of myoclonus, involving both platysmal muscles, in association with subclinical hyperthyroidism. The myoclonus was preceded by symptoms of hyperthyroidism, namely weight loss, menstrual disturbances, and heat intolerance. The movements abated with clonazepam and hyperthyroidism was treated with carbimazole. The myoclonus recurred briefly when she stopped taking clonazepam, but she has since remained well and euthyroid. Copyright 2005 Movement Disorder Society

[Evaluation of the diagnosis of subclinical endometritis in dairy cattle using ultrasound].

Science.gov (United States)

Lenz, Mirjam; Drillich, Marc; Heuwieser, Wolfgang

2007-01-01

The aim of this study was to determine signs of subclinical endometritis found by ultrasound that are associated with reduced fertility in dairy cows. The maximum diameter of the uterine lumen was determined by ultrasound in 324 cows without clinical signs of endometritis after evaluation of the genital tract 21 to 27 days postpartum. Cows were classified into healthy or with subclinical endometritis by three threshold values for the maximum uterine lumen diameter of 0.2 cm, 0.5 cm or 0.8 cm. Examinations by rectal palpation and ultrasound as well as classifications were repeated 14 days later. In addition, ovaries were scanned by ultrasound to determine the stage of the estrous cycle. In a subgroup of 103 cows the echotexture of the uterus and its contents was evaluated. In these cows the diagnosis of subclinical endometritis was performed by a scoring system. The diameter of the uterine lumen was significantly affected by stage of the estrous cycle at the time of examination. However, no effects were found for the stage of the cycle at the time of examination on subsequent reproductive performance. A uterine lumen with a maximum diameter of more than 0.2 cm showed a significant negative association with conception rate and proportion of cows pregnant. Classification based on higher threshold values did not reveal an association with reproductive performance. Echogenic content in the uterus also decreased reproductive performance. A classification based on the echotexture of the uterus and its contents revealed significant differences between healthy cows and cows with subclinical endometritis regarding the proportion of cows inseminated and pregnant. The results of this study showed that the diagnostic of bovine endometritis should be broadend by ultrasonography. The definition of subclinical endometritis diagnosed by means of ultrasonography has to be evaluated in further studies.

SUBCLINICAL HYPOTHYROIDISM IN METABOLIC SYNDROME AND ROLE OF CRP IN 50 ADULT PATIENTS

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Pratik Shah

2017-04-01

Full Text Available BACKGROUND Metabolic Syndrome (MetS is generally characterised as a clustering of the abnormal levels of blood lipids (low HDL and high triglycerides, impaired fasting glucose, elevated blood pressure, and excess abdominal obesity. The objectives of the study areTo evaluate presence of Subclinical Hypothyroidism in the study population of the patients with metabolic syndrome. To find out relation between Subclinical Hypothyroidism and different parameters of metabolic syndrome. To evaluate whether patients of metabolic syndrome with raised hs-CRP have an increased risk of having hypothyroidism. MATERIALS AND METHODS A total of 50 adult patients who met with inclusion criteria were selected. Patients with metabolic syndrome (MetS who fulfilled the NCEP-ATP III criteria: 3 out of 5 criteria positive. Patients with liver disorders, renal disorders, congestive cardiac failure, pregnant women, patients on oral contraceptive pills, statins and other medications that alter thyroid functions (e.g. lithium, amiodarone or γ-interferon were excluded from the study. RESULTS A total of 50 patients of metabolic syndrome were enrolled. Out of which 36 were euthyroid, 3 were overt hypothyroid and 11 were subclinical hypothyroid. Out of 11 patients of subclinical hypothyroidism, 9 were female and 2 were male patients. Out of 28 females, 9 (32% were SCH while out of 22 males, 2 (9% were SCH. Out of 50 patients, 3 were overt hypothyroid. All 3 patients had BP >130/85, waist circumference was >88 cm and HDL of 130/85, HDL 150 mg/dL and fasting blood glucose of >100 mg/dL were more associated with male patients. CONCLUSION Subclinical Hypothyroidism was present in 22% of study population and more so in females having metabolic syndrome (32%. Hence, it will be worthwhile to screen female metabolic syndrome patients for thyroid function abnormality. Abnormal blood pressure, triglycerides and HDL cholesterol levels were more associated with subclinical hypothyroidism

The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

Science.gov (United States)

Biondi, Bernadette; Bartalena, Luigi; Cooper, David S.; Hegedüs, Laszlo; Laurberg, Peter; Kahaly, George J.

2015-01-01

Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes. PMID:26558232

Surgical outcomes of laparoscopic adrenalectomy for patients with Cushing's and subclinical Cushing's syndrome: a single center experience.

Science.gov (United States)

Miyazato, Minoru; Ishidoya, Shigeto; Satoh, Fumitoshi; Morimoto, Ryo; Kaiho, Yasuhiro; Yamada, Shigeyuki; Ito, Akihiro; Nakagawa, Haruo; Ito, Sadayoshi; Arai, Yoichi

2011-12-01

We retrospectively examined the outcome of patients who underwent laparoscopic adrenalectomy for Cushing's/subclinical Cushing's syndrome in our single institute. Between 1994 and 2008, a total of 114 patients (29 males and 85 females, median age 54 years) with adrenal Cushing's/subclinical Cushing's syndrome were studied. We compared the outcome of patients who underwent laparoscopic adrenalectomy between intraperitoneal and retroperitoneal approaches. Surgical complications were graded according to the Clavien grading system. We also examined the long-term results of subclinical Cushing's syndrome after laparoscopic adrenalectomy. Laparoscopic surgical outcome did not differ significantly between patients with Cushing's syndrome and those with subclinical Cushing's syndrome. Patients who underwent laparoscopic intraperitoneal adrenalectomy had longer operative time than those who received retroperitoneal adrenalectomy (188.2 min vs. 160.9 min). However, operative blood loss and surgical complications were similar between both approaches. There were no complications of Clavien grade III or higher in either intraperitoneal or retroperitoneal approach. We confirmed the improvement of hypertension and glucose tolerance in patients with subclinical Cushing's syndrome after laparoscopic adrenalectomy. Laparoscopic adrenalectomy for adrenal Cushing's/subclinical Cushing's syndrome is safe and feasible in either intraperitoneal or retroperitoneal approach. The use of the Clavien grading system for reporting complications in the laparoscopic adrenalectomy is encouraged for a valuable quality assessment.

Subclinical laminitis and its association with pO2 and faecal alterations: Isikli, Aydin experience

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Ibrahim Akin

2015-05-01

Full Text Available ABSTRACT Objective. The aim of this field trial was to investigate the relationships among subclinical laminitis, hematological, ruminal and faecal alterations. Materials and Methods. To this extent dairy cows presenting subclinical laminitis (n=11 and to those of other healthy cows without laminitis (n=10 were enrolled and assigned into two groups. All animals were receiving the same daily ration formulated to contain 47% cornsilage and 18% hay, mainly. Effects of subclinical laminitis challenges on measurements of feces, and blood samples, were investigated to determine which of these measurements may aid in the diagnosis. pH changes in ruminal fluid collected via rumenocentesis were measured. Besides the following parameters were also measured; blood pH, faecal pH and faecal scoring. Blinded investigators performed the sample collection. Results. No statistical differences between the groups were detected for blood gas values studied regarding pCO2, HCO3, BE, indeed mean that pO2 values decreased statistically (p<0.05 and faecal pH was significantly decreased (p<0.05 in cows with subclinical laminitis in contrast to healthy controls. Conclusions. pO2 values and faecal pH may be valuable as indirect indicators of subclinical laminitis in cattle.

High Burden of Subclinical Lead Toxicity after Phase Out of Lead from Petroleum in Pakistan.

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Majid, Hafsa; Khan, Aysha Habib; Khan, Nadeem Ullah; Siddiqui, Imran; Ghani, Farooq; Jafri, Lena

2017-12-01

To evaluate the frequency of subclinical lead toxicity. Cross-sectional study. Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014. Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity. Amongst the total number of subjects tested (n=524), 26.5% (n=139) were children (lead level 16.9 ug/dl (36.1-4)] and lower level [4.2 ug/dl (6.8-2.6)] in children with lead levels while most had either subclinical (76%, n=106) or toxic lead levels (8%, n=11). In adults, (55%, n=212) subjects had desired lead levels, and 40% (n=154) and 4.99% (n=19) had subclinical and toxic lead levels. Presence of subclinical lead poisoning even after phasing out of lead petroleum in Pakistanis is alarming, especially in children. A national population-based study to determine the lead status and targeted intervention to identify potential sources is need of the time.

Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

International Nuclear Information System (INIS)

Arisaka, Hiraku

2000-01-01

Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

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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.

Detection of coronary calcification in ultrafast CT compared to coronary angiography

International Nuclear Information System (INIS)

Koesling, S.; Hoffmann, U.; Rother, T.; Lieberenz, S.; Heywang-Koebrunner, S.H.; Schulz, H.G.

1994-01-01

The angiographical findings of 24 patients with coronary artery disease were compared with qualitative and quantitative detection of coronary calcification by ultrafast CT. Doubts concerning the capabilities of the ultrafast CT for a screening of coronary artery disease arise when the results of one third false positive and fase negative findings are considered. Variations in the quantification of coronary calcification were too great to allow a realistic assessment of the degree of stenosis of the coronary arteries. (orig.) [de

Prevalence of subclinical mastitis in Finnish dairy cows: changes during recent decades and impact of cow and herd factors.

Science.gov (United States)

Hiitiö, Heidi; Vakkamäki, Johanna; Simojoki, Heli; Autio, Tiina; Junnila, Jouni; Pelkonen, Sinikka; Pyörälä, Satu

2017-04-20

The dairy industry has undergone substantial structural changes as intensive farming has developed during recent decades. Mastitis continues to be the most common production disease of dairy cows. Nationwide surveys of mastitis prevalence are useful in monitoring udder health of dairy herds and to study the impact of structural changes on the dairy industry. This survey on bovine subclinical mastitis was the first based on cow composite milk somatic cell count (SCC) data from the Finnish national health monitoring and milk recording database. A cow with composite milk SCC ≥200,000 cells/ml in at least one of the four test milkings during the year was considered to have subclinical mastitis and a cow with composite milk SCC ≥200,000 cells/ml in three or in all four test milkings during the year to have chronic subclinical mastitis. The aim of the study was to determine the prevalence of subclinical mastitis and chronic subclinical mastitis in Finland in 1991, 2001 and 2010 and to investigate cow and herd factors associated with elevated SCC. Prevalence of subclinical mastitis in Finland decreased over recent decades from 22.3% (1991) and 20.1% (2001) to 19.0% (2010). Prevalence of chronic subclinical mastitis was 20.4% in 1991, 15.5% in 2001 and 16.1% in 2010. The most significant cow and herd factors associated with subclinical mastitis or high milk SCC were increasing parity, Holstein breed, free-stalls with an automatic milking system and organic production. Milk SCC were highest from July to September. Main factors associated with chronic mastitis were increasing parity and Holstein breed. Prevalence of subclinical mastitis in Finland decreased over recent decades, the greatest change taking place during the first decade of the study. Prevalence of chronic subclinical mastitis significantly decreased from 1991. The most significant factors associated with both types of mastitis were increasing parity and Holstein breed, and for subclinical mastitis also

High prevalence of subclinical atherosclerosis in Brazilian postmenopausal women with low and intermediate risk by Framingham score.

Science.gov (United States)

Petisco, Ana Claudia Gomes Pereira; Assef, Jorge Eduardo; de Jesus, Carlos Alberto; Saleh, Mohamed Hassan; Barbosa, Jose Eduardo Martins; Costa de Souza Le Bihan, David; Pinto, Ibraim Masciarelli França; Rolim Fernandes Fontes Pedra, Simone; Barretto, Rodrigo Bellio de Mattos; Sousa, Amanda Guerra de Moraes Rego

2017-03-01

Cardiovascular diseases are the leading cause of mortality among women in several countries. Early detection of subclinical atherosclerosis (SA) could enable the adoption of preventive measures to avoid cardiovascular events. This study aimed to determine the prevalence of SA in Brazilian asymptomatic postmenopausal women in Framingham Risk Score (FRS) low and intermediate groups. Computed tomography (CT) and ultrasound (US) scans were performed in 138 asymptomatic postmenopausal women (56.1 ± 4.9 years of age) to survey for coronary artery and aortic calcification (CT scan) and assess carotid intima-media thickness (CIMT) and identify carotid plaques (US). The mean FRS was 2.64 ± 2.13 %. The prevalence of increased CIMT, carotid plaques, increased CIMT and/or plaques, coronary artery calcification (CAC) >0 and aortic calcification (AC) were, respectively, 45.7, 37.7, 62.3, 23.9 and 45.7 %. Normal imaging tests were found in 22.4 %. SA, defined as at least one abnormal imaging test, was associated with age, FRS, waist-to-rip ratio, systolic and diastolic blood pressure, HDL-c and ApoA1 levels, and ApoA1/ApoB ratio. In logistic regression, SA was associated with higher age (OR 1.108, 95 % CI 1.010-1.215, p = 0.029) and lower ApoA1 levels (OR 0.979, 95 % CI 0.960-0.998, p = 0.029). SA was prevalent in Brazilian postmenopausal women with low and intermediate risk groups (FRS) and was associated with higher age and lower levels of ApoA1. Carotid atherosclerosis was the most common presentation of SA in this group.

Cluster analysis reveals subclinical subgroups with shared autistic and schizotypal traits.

Science.gov (United States)

Ford, Talitha C; Apputhurai, Pragalathan; Meyer, Denny; Crewther, David P

2018-07-01

Autism and schizophrenia spectrum research is typically based on coarse diagnostic classification, which overlooks individual variation within clinical groups. This method limits the identification of underlying cognitive, genetic and neural correlates of specific symptom dimensions. This study, therefore, aimed to identify homogenous subclinical subgroups of specific autistic and schizotypal traits dimensions, that may be utilised to establish more effective diagnostic and treatment practices. Latent profile analysis of subscale scores derived from an autism-schizotypy questionnaire, completed by 1678 subclinical adults aged 18-40 years (1250 females), identified a local optimum of eight population clusters: High, Moderate and Low Psychosocial Difficulties; High, Moderate and Low Autism-Schizotypy; High Psychosis-Proneness; and Moderate Schizotypy. These subgroups represent the convergent and discriminant dimensions of autism and schizotypy in the subclinical population, and highlight the importance of examining subgroups of specific symptom characteristics across these spectra in order to identify the underlying genetic and neural correlates that can be utilised to advance diagnostic and treatment practices. Copyright © 2018 Elsevier B.V. All rights reserved.

Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events

DEFF Research Database (Denmark)

Selmer, Christian; Olesen, Jonas Bjerring; Hansen, Morten Lock

2014-01-01

hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)]. CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality....

Evaluating sub-clinical cognitive dysfunction and event-related potentials (P300) in clinically isolated syndrome.

Science.gov (United States)

Kocer, Belgin; Unal, Tugba; Nazliel, Bijen; Biyikli, Zeynep; Yesilbudak, Zulal; Karakas, Sirel; Irkec, Ceyla

2008-12-01

This study investigated the presence of sub-clinical cognitive dysfunction in patients with clinically isolated syndrome (CIS) and the abnormalities of cognitive event-related potentials (ERPs). Subclinical cognitive dysfunction was assessed in 20 patients with CIS and in 20 healthy controls. Patients had impairments in verbal learning and long-term memory, evaluating attention, executive function and visuospatial skills, in decreasing order of frequency. SDLT and SIT were the most, and COWAT and BNT were the least affected tests. The N200 and P200 latencies were prolonged, and N100, N200 and P200 amplitudes were reduced in the patients relative to the controls, from the Fz, Cz and Pz electrode positions (p<0.05). Detailed cognitive testing is valuable in determining subclinical cognitive dysfunction in CIS patients. ERP abnormalities as well as abnormalities in detailed cognitivetesting in patients with CIS are helpful in the diagnosis of sub-clinical cognitive dysfunction.

Stochastic modelling to assess economic effects of treatment of chronic subclinical mastitis caused by Streptococcus uberis.

Science.gov (United States)

Steeneveld, Wilma; Swinkels, Jantijn; Hogeveen, Henk

2007-11-01

Chronic subclinical mastitis is usually not treated during the lactation. However, some veterinarians regard treatment of some types of subclinical mastitis to be effective. The goal of this research was to develop a stochastic Monte Carlo simulation model to support decisions around treatment of chronic subclinical mastitis caused by Streptococcus uberis. Factors in the model included the probability of cure after treatment, probability of the cow becoming clinically diseased, transmission of infection to other cows, and physiological effects of the infection. Using basic input parameters for Dutch circumstances, the average economic costs per cow of an untreated chronic subclinical mastitis case caused by Str. uberis in a single quarter from day of diagnosis onwards was euro109. With treatment, the average costs were higher (euro120). Thus, for the average cow, treatment was not efficient economically. However, the risk of high costs was much higher when cows with chronic subclinical mastitis were not treated. A sensitivity analysis showed that profitability of treatment of chronic subclinical Str. uberis mastitis depended on farm-specific factors (such as economic value of discarded milk) and cow-specific factors (such as day of diagnosis, duration of infection, amount of transmission to other cows and cure rate). Therefore, herd level protocols are not sufficient and decision support should be cow specific. Given the importance of cow-specific factors, information from the current model could be applied to automatic decision support systems.

LESIONS ASSOCIATED WITH SUBCLINICAL LAMINITIS AND DIGITAL RADIOGRAPHIC EXAM IN HOLSTEIN COWS IN THE TRANSITIONAL PERIOD

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Antonio Amaral Barbosa

2016-10-01

Full Text Available Subclinical laminitis has been responsible for economic losses in dairy industry; thus, its diagnostic    is very important to prevent negative responses to milk production industry. The aim of this study  was to identify lesions associated with subclinical laminitis during the transition period with presence or absence of radiographic signs linked to this disease in Holstein cows. The cows were evaluated during the transition period and categorized into two groups (with and without laminitis according to the lesions associated with this subclinical disease. The radiological dynamic was performed in two target points during the transition period (prepartum and postpartum, with the objective of determining capsular position possible alterations and third phalanx bone degeneration (F3. There was no effect of the presence of lesions associated with subclinical laminitis regarding the position of the third phalanx to the hoof wall (p>0.05. Significant radiographic angular differences (p0.05. Overall, this study did not show radiographic signs of phalangeal misalignment in the hoof of dairy cows with lesions associated with subclinical laminitis during the transition period . Keywords:  aseptic pododermatitis; bovines; complementary exams; hoof.

Subclinical hypothyroidism in children with Down syndrome: To treat ...

African Journals Online (AJOL)

Mohamed El Kholy

2014-12-01

Dec 1, 2014 ... In children with subclinical hypothyroidism, The American. Thyroid Association ... reflects mild hypothyroidism that could harm brain growth and development in the ... results in a normal cognitive development [9]. In conclusion ...

Prevalence of subclinical Cardiovascular Disease in healthy HIV ...

African Journals Online (AJOL)

We tested for subclinical CVD using 3 tools: Ankle Brachial Index (ABI) to measure for the presence of peripheral artery disease, 12 lead Electrocardiogram (ECG) for electrical abnormalities and transthoracic Echocardiography (ECHO), to measure abnormalities in cardiac structure and function. At analysis, patients where ...

Relation of Dietary Glycemic Index and Glycemic Load to Coronary Artery Calcium in Asymptomatic Korean Adults.

Science.gov (United States)

Choi, Yuni; Chang, Yoosoo; Ryu, Seungho; Cho, Juhee; Kim, Mi Kyung; Ahn, Younjhin; Lee, Jung Eun; Sung, Eunju; Kim, Boyoung; Ahn, Jiin; Kim, Chan-Won; Rampal, Sanjay; Zhao, Di; Zhang, Yiyi; Pastor-Barriuso, Roberto; Lima, Joao A C; Chung, Eun Chul; Shin, Hocheol; Guallar, Eliseo

2015-08-15

The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association. Copyright © 2015 Elsevier Inc. All rights reserved.

[Activity of antioxidative enzymes and concentration of malondialdehyde as oxidative status markers in women with non-autoimmunological subclinical hyperthyroidism].

Science.gov (United States)

Rybus-Kalinowska, Barbara; Zwirska-Korczala, Krystyna; Kalinowski, Mariusz; Kukla, Michał; Birkner, Ewa; Jochem, Jerzy

2009-01-01

The recent investigations point out the significant role of oxidative stress in the development of thyroid gland disease. The present study was designed to investigate the variation of oxidative stae in women with non-autoimmunological subclinical hyperthyroidism. The study was conducted on 20 females with non-autoimmunological subclinical hyperthyroidism and 15 healthy women. Manganase-containing superoxide dismutase (Mn-SOD) and extracellular superoxide dismutase (EC-SOD) plasma activity, and malondialdehyde (MDA) plasma concentration were measured. EC-SOD plasma activity was significantly higher in women with subclinical hyperthyroidism when compared with the control group (13.3 +/- 2.1 vs. 10.9 +/- 1.4 NU/ml; p < 0.05), unlike Mn-SOD (4.2 +/- 0.5 vs. 4.0 +/- 1.0 NU/ml). MDA plasma concentration increased significantly in women with subclinical hyperthyroidism (3.5 +/- 1.2 vs. 2.0 +/- 0.6 micromol/l; p < 0.05). The increased EC-SOD plasma activity may reflect disturbances of oxidative state in subclinical hyperthyroidism. Parallel increase of MDA plasma concentration may indicate enhancement of lipid peroxidationin in patients with subclinical hyperthyroidism.

Subclinical thyroid dysfunction and psychiatric disorders: cross-sectional results from the Brazilian Study of Adult Health (ELSA-Brasil).

Science.gov (United States)

Benseñor, Isabela M; Nunes, Maria Angélica; Sander Diniz, Maria de Fátima; Santos, Itamar S; Brunoni, André R; Lotufo, Paulo A

2015-01-12

To evaluate the association between subclinical thyroid dysfunction and psychiatric disorders using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectional study. The study included 12 437 participants from the ELSA-Brasil with normal thyroid function (92·8%), 193 (1·4%) with subclinical hyperthyroidism and 784 (5·8%) with subclinical hypothyroidism, totalling 13 414 participants (50·6% of women). The mental health diagnoses of participants were assessed by trained raters using the Clinical Interview Schedule - Revised (CIS-R) and grouped according to the International Classification of Diseases 10 (ICD-10). Thyroid dysfunction was assessed using TSH and FT4 as well as routine use of thyroid hormones or antithyroid medications. Logistic models were presented using psychiatric disorders as the dependent variable and subclinical thyroid disorders as the independent variable. All logistic models were corrected for multiple comparisons using Bonferroni correction. After multivariate adjustment for possible confounders, we found a direct association between subclinical hyperthyroidism and panic disorder odds ratio [OR], 2·55; 95% confidence Interval (95% CI), 1·09-5·94; and an inverse association between subclinical hypothyroidism and generalized anxiety disorder (OR, 0·75; 95% CI, 0·59-0·96). However, both lost significance after correction for multiple comparisons. Subclinical hyperthyroidism was positively associated with panic disorder and negatively associated with anxiety disorder, although not significant after adjustment for multiple comparisons. © 2015 John Wiley & Sons Ltd.

Pattern classification of brain activation during emotional processing in subclinical depression: psychosis proneness as potential confounding factor.

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Modinos, Gemma; Mechelli, Andrea; Pettersson-Yeo, William; Allen, Paul; McGuire, Philip; Aleman, Andre

2013-01-01

We used Support Vector Machine (SVM) to perform multivariate pattern classification based on brain activation during emotional processing in healthy participants with subclinical depressive symptoms. Six-hundred undergraduate students completed the Beck Depression Inventory II (BDI-II). Two groups were subsequently formed: (i) subclinical (mild) mood disturbance (n = 17) and (ii) no mood disturbance (n = 17). Participants also completed a self-report questionnaire on subclinical psychotic symptoms, the Community Assessment of Psychic Experiences Questionnaire (CAPE) positive subscale. The functional magnetic resonance imaging (fMRI) paradigm entailed passive viewing of negative emotional and neutral scenes. The pattern of brain activity during emotional processing allowed correct group classification with an overall accuracy of 77% (p = 0.002), within a network of regions including the amygdala, insula, anterior cingulate cortex and medial prefrontal cortex. However, further analysis suggested that the classification accuracy could also be explained by subclinical psychotic symptom scores (correlation with SVM weights r = 0.459, p = 0.006). Psychosis proneness may thus be a confounding factor for neuroimaging studies in subclinical depression.

Cardiovascular Risk Factors in Subclinical Hypothyroidism: A Case Control Study in Nepalese Population

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Rajendra KC

2015-01-01

Full Text Available Objectives. To assess cardiovascular risk factors in Nepalese population with subclinical hypothyroidism as compared to age and sex matched controls. Materials and Methods. A case control study was conducted among 200 subjects (100 subclinical hypothyroid and 100 euthyroid at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Demographic and anthropometric variables including systolic and diastolic blood pressure (BP were taken. Blood samples were assayed for serum free triiodothyronine (fT3, free thyroxine (fT4, thyroid stimulating hormone (TSH, total cholesterol (TC, high density lipoprotein cholesterol (HDL-C, low density lipoprotein cholesterol (LDL-C, and high sensitivity C reactive protein (hs-CRP. Results. Subclinical hypothyroid patients had significantly higher diastolic BP, total cholesterol, LDL cholesterol, and hs-CRP than controls. The odds ratio of having hypercholesterolemia (>200 mg/dL, low HDL cholesterol (100 mg/dL, high hs-CRP (>1 mg/L, and high diastolic BP (>80 mmHg and being overweight (BMI ≥ 23 Kg/m2 in subclinical hypothyroidism was 2.29 (95% CI; 1.2–4.38, p=0.011, 1.73 (95% CI; 0.82–3.62, p=0.141, 3.04 (95% CI; 1.66–5.56, p<0.001, 2.02 (95% CI; 1.12–3.64, p=0.018, 3.35 (95% CI; 1.72–6.55, p<0.001, and 0.9 (95% CI; 0.48–1.67, p=0.753, respectively, as compared to controls. Conclusion. Subclinical hypothyroid patients are associated with higher risk for cardiovascular disease than euthyroid subjects.

SUBCLINICAL HYPOTHYROIDISM CURRENT CONCEPTS & M ANAGEMENT STRATEGEIES

OpenAIRE

Radha Krishnan; Soumini; Adithya

2015-01-01

Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone ( TSH ) and normal free T3 & T4 , without clinical features of hypothyroidism . Clinical significance of SCH remains uncertain and controversial . Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms . There are still controversies surrounding SCH and associated risk of ...

Hemostasis in Overt and Subclinical Hyperthyroidism

Science.gov (United States)

Ordookhani, Arash; Burman, Kenneth D.

2017-01-01

Context There are contradictory results on the effect of hyperthyroidism on hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). The present review focuses on hemostatic changes in overt and subclinical hyperthyroidism. Methods A systematic literature search was conducted employing MEDLINE database. The following words were used for the search: Hyperthyroidism; thyrotoxicosis; Graves disease; goiter, nodular; hemostasis; blood coagulation factors; blood coagulation disorders; venous thromboembolism; bleeding; fibrinolysis. The articles that were related to hyperthyroidism and hemostasis are used in this manuscript. Results Hyperthyroidism, either overt or subclinical, renders a hypercoagulable state, although there are several studies with contradictory findings in the literature. Hypercoagulability may be caused by an increase in the level of various coagulation factors such as factor (F) VIII, FX, FIX, von Willebrand F (vWF), and fibrinogen, while hypofibrinolysis by changes in coagulation parameters such as a decrease in plasmin and plasmin activator or an increase in α2-antiplasmin, plasminogen activator inhibitor-1 and thrombin activatable fibrinolysis inhibitor Conclusions Although many reports are in favor of a hypercoagulable state in overt hyperthyroidism but this finding at the biochemical level and its clinical implication, on the occurrence of VTE, has yet to be confirmed. PMID:29201071

Improvement in subclinical cognitive dysfunction with thyroxine therapy in hypothyroidism: A study from tertiary care center

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Sridevi Paladugu

2015-01-01

Full Text Available Aim: To evaluate the effect of hypothyroidism (both overt and subclinical on cognitive function using latencies of P300 auditory evoked potentials (AEPs. P300 latency suggests that shorter latency times are related to better cognitive performance. P300 latencies were also done after thyroxine replacement to see the effect of treatment on cognitive function. Materials and Methods: Biochemically proven new onset cases with hypothyroidism (overt and subclinical were enrolled into the study, AEPs of these two groups when compared with matched controls. After detailed history and physical examination, P300 potentials were recorded at two points Cz and Pz (Cz: On the midline of the head at the vertex, Pz: On the midline of the head between the vertex and occipital protuberance using a Nicolet Viking Select neuro diagnostic system version 10.0. The study was done in electrophysiology lab in Osmania Medical College. Results: A patient characteristics of both cases and controls were comparable. The cases consisted of two groups, overt hypothyroid cases 24, mean thyroid stimulating hormone (TSH values in them was 94, subclinical cases 21 in whom mean TSH value was 12.3. Mean P300 latencies of all cases at Cz was 342.42 ± 29.5 ms, and at Pz was 345.4 ± 30 ms. Mean P300 latencies of controls at Cz was 296.4 ± 34 ms and at Pz was 297.9 ± 33 ms (difference in P < 0.001. Mean P300 values in overt cases were 362.6 ± 32.9 ms at Cz, and at Pz it was 362.5 ± 33.9 ms. Mean P300 values in subclinical cases were 319.3 ± 30.9 ms at Cz, and at Pz it was 316.4 ± 27.9 ms. P300 values in overt cases were highly significant as compared to controls, and P300 values in the subclinical cases versus controls were also significant (P < 0.001. Conclusion: P300 latency prolongation in both clinical and subclinical hypothyroid cases shows that cognitive function is affected adversely in hypothyroidism including the subclinical hypothyroid cases. Larger studies evaluating

Inversion prepared coronary MR angiography: direct visualization of coronary blood flow

International Nuclear Information System (INIS)

Katoh, M.; Spuentrup, E.; Buecker, A.; Guenther, R.W.; Stuber, M.; Manning, W.J.; Botnar, R.M.

2005-01-01

Purpose: visualization of coronary blood flow by means of a slice-selective inversion pre-pulse in concert with bright-blood coronary MRA. Materials and methods: coronary magnetic resonance angiography (MRA) of the right coronary artery (RCA) was performed in eight healthy adult subjects on a 1.5 Tesla MR system (Gyroscan ACS-NT, Philips Medical Systems, Best, NL) using a free-breathing navigator-gated and cardiac-triggered 3D steady-state free-precession (SSFP) sequence with radial k-space sampling. Imaging was performed with and without a slice-selective inversion pre-pulse, which was positioned along the main axis of the coronary artery but perpendicular to the imaging volume. Objective image quality parameters such as SNR, CNR, maximal visible vessel length, and vessel border definition were analyzed. Results: in contrast to conventional bright-blood 3D coronary MRA, the selective inversion pre-pulse provided a direct measure of coronary blood flow. In addition, CNR between the RCA and right ventricular blood pool was increased and the vessels had a tendency towards better delineation. Blood SNR and CNR between right coronary blood and epicardial fat were comparable in both sequences. (orig.)

Subclinical hypothyroidism in obese children

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Aleksandra Januszek-Trzciąkowska

2013-08-01

Full Text Available Subclinical hypothyroidism (SH is defined as an elevated thyroid stimulating hormone (TSH associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.

[Subclinical hypothyroidism in obese children].

Science.gov (United States)

Januszek-Trzciąkowska, Aleksandra; Małecka-Tendera, Ewa

2013-08-05

Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.

Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment.

Science.gov (United States)

Maraka, Spyridoula; Mwangi, Raphael; McCoy, Rozalina G; Yao, Xiaoxi; Sangaralingham, Lindsey R; Singh Ospina, Naykky M; O'Keeffe, Derek T; De Ycaza, Ana E Espinosa; Rodriguez-Gutierrez, Rene; Coddington, Charles C; Stan, Marius N; Brito, Juan P; Montori, Victor M

2017-01-25

 To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.  Retrospective cohort study.  Large US administrative database between 1 January 2010 and 31 December 2014.  5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L.  Thyroid hormone therapy.  Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes.  Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (Ptreatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (Ptreatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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.

Stochastic modelling to assess economic effects of treatment of chronic subclinical mastitis caused by Streptococcus uberis

NARCIS (Netherlands)

Steeneveld, W.; Swinkels, J.; Hogeveen, H.

2007-01-01

Chronic subclinical mastitis is usually not treated during the lactation. However, some veterinarians regard treatment of some types of subclinical mastitis to be effective. The goal of this research was to develop a stochastic Monte Carlo simulation model to support decisions around treatment of

The prevalence of subclinical hypothyroidism among patients with ...

African Journals Online (AJOL)

2012-10-03

Oct 3, 2012 ... Original Research: The prevalence of subclinical hypothyroidism among patients with diabetes mellitus. 106. 2013 Volume 18 No 2. JEMDSA. Introduction. Diabetes mellitus and its associated complications is a major challenge for both the private and state health sector in South Africa. The number of ...

Antimicrobial resistance profile in bacterial isolates from subclinical ...

African Journals Online (AJOL)

This study was undertaken to investigate subclinical mastitis causing pathogens in dairy lactating cows and determine their antimicrobial susceptibility profile in rural and peri-urban areas of Thika, Mathioya and Kieni East Sub County. California Mastitis Test (CMT) was used to screen one hundred and sixteen lactating ...

Subclinical hypothyroidism ups the risk of vascular complications in ...

African Journals Online (AJOL)

Subclinical hypothyroidism ups the risk of vascular complications in type 2 diabetes. ... hypothyroidism (SCH) and vascular complications of type 2 diabetes. ... However, gender (p = 0.076), BMI (p = 0.092), and smoking (P = 0.715) were not ...

Association of claw disorders with subclinical intramammary infections in Egyptian dairy cows

DEFF Research Database (Denmark)

Refaal, Walid; Mahmmod, Yasser

2017-01-01

Aim: Bovine mastitis and lameness are the most common production diseases affecting dairy farms worldwide resulting in huge economic impact and impaired animal welfare. The objective of this field study was to investigate the association of infectious and non-infectious claw disorders...... with the occurrence of subclinical intramammary infections (IMIs) diagnosed by California mastitis test (CMT) in dairy cows under Egyptian conditions. Materials and Methods: A total of 43 dairy cows were included in this field study. Subclinical IMI was diagnosed by CMT on all lactating quarters of cows. A cow...

The Intricate Relationship between Psychotic-Like Experiences and Associated Subclinical Symptoms in Healthy Individuals

Science.gov (United States)

Unterrassner, Lui; Wyss, Thomas A.; Wotruba, Diana; Haker, Helene; Rössler, Wulf

2017-01-01

The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE) although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20–60 years, 73 females) using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ). The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1) most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2) magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3) similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4) ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings indicated that

The Intricate Relationship between Psychotic-Like Experiences and Associated Subclinical Symptoms in Healthy Individuals

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Lui Unterrassner

2017-09-01

Full Text Available The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20–60 years, 73 females using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ. The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1 most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2 magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3 similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4 ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings

Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.

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Baumgartner, Christine; da Costa, Bruno R; Collet, Tinh-Hai; Feller, Martin; Floriani, Carmen; Bauer, Douglas C; Cappola, Anne R; Heckbert, Susan R; Ceresini, Graziano; Gussekloo, Jacobijn; den Elzen, Wendy P J; Peeters, Robin P; Luben, Robert; Völzke, Henry; Dörr, Marcus; Walsh, John P; Bremner, Alexandra; Iacoviello, Massimo; Macfarlane, Peter; Heeringa, Jan; Stott, David J; Westendorp, Rudi G J; Khaw, Kay-Tee; Magnani, Jared W; Aujesky, Drahomir; Rodondi, Nicolas

2017-11-28

Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF. © 2017 American Heart Association, Inc.

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

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Stott, D.J.; Rodondi, N.; Kearney, P.M.; Ford, I.; Westendorp, R.G.; Mooijaart, S.P.; Sattar, N.; Aubert, C.E.; Aujesky, D.; Bauer, D.C.; Baumgartner, C.; Blum, M.R.; Browne, J.P.; Byrne, S.; Collet, T.H.; Dekkers, O.M.; Elzen, W.P. den; Puy, R.S. Du; Ellis, G.; Feller, M.; Floriani, C.; Hendry, K.; Hurley, C.; Jukema, J.W.; Kean, S.; Kelly, M.; Krebs, D.; Langhorne, P.; McCarthy, G.; McCarthy, V.; McConnachie, A.; McDade, M.; Messow, M.; O'Flynn, A.; O'Riordan, D.; Poortvliet, R.K.; Quinn, T.J.; Russell, A.; Sinnott, C.; Smit, J.W.A.; Dorland, H.A. Van; Walsh, K.A.; Walsh, E.K.; Watt, T.; Wilson, R.; Gussekloo, J.

2017-01-01

BACKGROUND: The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. METHODS: We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving

Diagnosing coronary artery disease after a positive coronary computed tomography angiography

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Nissen, L; Winther, S; Westra, J

2018-01-01

Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim...

Pattern classification of brain activation during emotional processing in subclinical depression: psychosis proneness as potential confounding factor

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Gemma Modinos

2013-02-01

Full Text Available We used Support Vector Machine (SVM to perform multivariate pattern classification based on brain activation during emotional processing in healthy participants with subclinical depressive symptoms. Six-hundred undergraduate students completed the Beck Depression Inventory II (BDI-II. Two groups were subsequently formed: (i subclinical (mild mood disturbance (n = 17 and (ii no mood disturbance (n = 17. Participants also completed a self-report questionnaire on subclinical psychotic symptoms, the Community Assessment of Psychic Experiences Questionnaire (CAPE positive subscale. The functional magnetic resonance imaging (fMRI paradigm entailed passive viewing of negative emotional and neutral scenes. The pattern of brain activity during emotional processing allowed correct group classification with an overall accuracy of 77% (p = 0.002, within a network of regions including the amygdala, insula, anterior cingulate cortex and medial prefrontal cortex. However, further analysis suggested that the classification accuracy could also be explained by subclinical psychotic symptom scores (correlation with SVM weights r = 0.459, p = 0.006. Psychosis proneness may thus be a confounding factor for neuroimaging studies in subclinical depression.

Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

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Nielsen, L.; Bøtker, H. E.; Sorensen, H.

2015-01-01

Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

Intrahepatic cholestasis in subclinical and overt hyperthyroidism: two case reports

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Soylu Aliye

2008-04-01

Full Text Available Abstract Introduction Non-specific abnormalities in liver function tests might accompany the clinical course of hyperthyroidism. Hyperthyroidism can cause the elevation of hepatic enzymes and bilirubin. Jaundice is rare in overt hyperthyroidism, especially in subclinical hyperthyroidism. On the other hand, the use of anti-thyroid drugs has rarely been associated with toxic hepatitis and cholestatic jaundice. Case presentation Here we present two cases of cholestasis that accompanied two distinct forms of clinical hyperthyroidism. The first patient had a clinical presentation of severe cholestasis in the absence of congestive failure related to hyperthyroidism. The second case had developed intrahepatic cholestasis in the presence of subclinical hyperthyroidism, and improved with rifampicin treatment. Conclusion Hyperthyroidism should be a consideration in non-specific liver dysfunction.

Coronary hemodynamics in vasospastic angina

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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)

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

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Faber, J; Wiinberg, N; Schifter, S

2001-01-01

rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T4) and tri-iodothyronine (T3) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography...

Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

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Toischer Karl

2009-09-01

Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

California mastitis test in the diagnostic of subclinical mastitis

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Adna Crisléia Rodrigues Monção de Lima

2013-12-01

Full Text Available Milk production in Brazil is undoubtedly one of the most important Brazilian agroindustrial complex. Moves large sums of money, the dairy industry employs millions of the people, having potential to provide the domestic and foreign markets. Besides surpassing year by year the index production. The quality of milk is increasingly demanded by consumers and there are bonus programs for milk with low somatic cell counts, which reveal, indirectely, the udder sanity. Mastitis, the udder inflamation, is the main factor that substantially compromises the milk quality. Several methods can diagnose the incidence of subclinical mastitis in dairy herds. One these methods, the California Mastitis Test (CMT has as advantages being practical, low cost and the results are immediately available. The CMT method consists of adding the anionic neutral detergent to a milk sample in order to disrupt milk somatic cell membranes and release nucleic material. The viscousity formed by this reaction allows estimating the number of somatic cells (immunity cells presents in the milk. According to the degree of gelatinization obtained in this reaction, the interpretation of the scores varies from zero, no viscosity, to three crosses, highly viscous. This study was aimed to evaluate the CMT of eight dairy herds of different farms in Sao Paulo state, described by the letters A to H. The scores 1, 2 and 3 were considered positive for subclinical mastitis, while 0 was negative. The results were determined in relative frequency (%. It is evident that the herd D is the most affected by subclinical mastitis, because of the greater number of CMT positive (60%. This may be due to the mismanagement and poor conditions of milking. The properties C, F and G require greater attention, as the result of CMT could corroborate the presence of pathogenic microorganisms and infected cows can quickly transmit the infection to the healthy ones. Note that the farms A, B and H are the ones with

Homeostatic Model Assessment-Insulin Resistance (HOMA-IR 2) in Mild Subclinical Hypothyroid Subjects.

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Sengupta, Shreejita; Jaseem, T; Ambalavanan, Jayachidambaram; Hegde, Anupama

2018-04-01

Despite various studies with conflicting results, the effect of thyroid hormones on lipids and insulin levels in dysthyroidism is of great interest. This case control study was aimed to perceive the existence of IR and dyslipidemia in mild subclinical hypothyroid subjects (TSH ≤ 9.9 µIU/ml) as compared to their age and gender matched euthyroid controls. Basic demographic information like height, weight was recorded. Serum samples of all the subjects were assayed for thyroid profile, lipid profile, blood glucose, HbA1C and insulin. BMI and insulin resistance was calculated. Compared to controls patients with mild subclinical hypothyroidism demonstrated hyperinsulinemia and dyslipidemia observed by the higher LDL cholesterol. A significantly positive correlation was observed for HOMA-IR with TSH and LDL cholesterol. Hence, even in the mild subclinical hypothyroid state assessment of thyroid function should be combined with estimation of plasma glucose, insulin and serum lipids to monitor and prevent its associated effects.

Chocolate Consumption is Inversely Associated with Calcified Atherosclerotic Plaque in the Coronary Arteries: The NHLBI Family Heart Study

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Djoussé, Luc; Hopkins, Paul N.; Arnett, Donna K.; Pankow, James S.; Borecki, Ingrid; North, Kari E.; Ellison, R. Curtis

2010-01-01

Background and Aims While a diet rich in anti-oxidant has been favorably associated with coronary disease and hypertension, limited data have evaluated the influence of such diet on subclinical disease. Thus, we sought to examine whether chocolate consumption is associated with calcified atherosclerotic plaque in the coronary arteries (CAC). Methods In a cross-sectional design, we studied 2,217 participants of the NHLBI Family Heart Study. Chocolate consumption was assessed by a semi-quantitative food-frequency questionnaire and CAC was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Results There was an inverse association between frequency of chocolate consumption and prevalent CAC. Odds ratios (95% CI) for CAC were 1.0 (reference), 0.94 (0.66-1.35), 0.78 (0.53-1.13), and 0.68 (0.48-0.97) for chocolate consumption of 0, 1-3 times per month, once per week, and 2+ times per week, respectively (p for trend 0.022), adjusting for age, sex, energy intake, waist-hip ratio, education, smoking, alcohol consumption, ratio of total-to-HDL-cholesterol, non-chocolate candy, and diabetes mellitus. Controlling for additional confounders did not alter the findings. Exclusion of subjects with coronary heart disease or diabetes mellitus did not materially change the odds ratio estimates but did modestly decrease the overall significance (p = 0.07). Conclusions These data suggest that chocolate consumption might be inversely associated with prevalent CAC. PMID:20655129

[Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

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Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

2009-09-01

To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

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

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT.

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Tang, Lijun; Zhu, Xiaomei; Xu, Yi; Yu, Tongfu; Xu, Hai; Tang, Jinhua; Dogra, Vikram; Wang, Dehang

2011-02-01

CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight × height/3600](1/2)) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 × HR + 1.902 × gender + 0.394 × TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 × HR-3.293 × weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Delay time is influenced by HR, gender and TCD. Coronary arterial density also changes with HR and weight. So HR, gender, TCD and

Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease

International Nuclear Information System (INIS)

Tsukamoto, Takahiro; Naya, Masanao; Tsutsui, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Inubushi, Masayuki; Kuge, Yuji; Tamaki, Nagara

2006-01-01

Myocardial flow reserve (MFR) measurement has an important role in assessing the functional severity of coronary artery stenosis. However, a discrepancy between the anatomical severity of coronary artery stenosis and MFR is often observed. Such a discrepancy may be explained by coronary risk factors. In this study, we aimed to investigate the influence of coronary artery stenosis severity and risk factors on MFR. Seventy-four patients suspected to have coronary artery disease and seven age-matched healthy volunteers were enrolled. Myocardial blood flow (MBF) and MFR were measured using 15 O-labelled water PET. Regional MFR was calculated in regions with significant coronary artery stenosis (stenotic regions) and in regions without significant stenosis (remote regions). The contributions of coronary artery stenosis severity and coronary risk factors were assessed using univariate and multivariate analyses. In stenotic regions, MFR correlated inversely with coronary artery stenosis severity (r=-0.50, p<0.01). Univariate analysis did not show any significant difference in MFR between the patients with and the patients without each risk factor. In remote regions, however, MFR was significantly decreased in the diabetes and smoking groups (each p<0.05). By multivariate analysis, diabetes and smoking were independent predictors of MFR (each p<0.05). In the group with more than one risk factor, MFR was significantly lower (2.78±0.79) than in the other group (3.40±1.22, p<0.05). MFR is influenced not only by coronary stenosis severity but also by coronary risk factors. In particular, the influence of risk factors should be considered in regions without severe coronary stenosis. (orig.)

Coronary artery aneurysms

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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.

Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study

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Anne-Dorthe Feldthusen

2015-01-01

Full Text Available Introduction. The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb, and mild (subclinical hypothyroidism in women from The Danish General Suburban Population Study (GESUS on the number of children born, the number of pregnancies, and the number of spontaneous abortions. Methods. Retrospective cross sectional study of 11254 women participating in GESUS. Data included biochemical measurements and a self-administrated questionnaire. Results. 6.7% had mild (subclinical hypothyroidism and 9.4% prevalent hypothyroidism. In women with mild hypothyroidism TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated with spontaneous abortions. Mild (subclinical hypothyroidism was associated with a risk of not having children and a risk of not getting pregnant in age-adjusted and multiadjusted models. Prevalent hypothyroidism was not associated with the number of children born, the number of pregnancies, or spontaneous abortions. Conclusion. Impaired fertility is associated with TSH, TPOAb, and mild (subclinical hypothyroidism in a Danish population of women.

Prevalence of bovine subclinical mastitis and isolation of its major causes in Bishoftu Town, Ethiopia.

Science.gov (United States)

Birhanu, Misrak; Leta, Samson; Mamo, Gezahegne; Tesfaye, Shimelis

2017-12-21

A cross-sectional study was conducted from November 2015 to March 2016 to estimate the prevalence, to assess the risk factors and to isolate the major etiological agent of subclinical mastitis in Bishoftu town. The study was conducted on 262 cross breed lactating cows selected from 12 intensively managed dairy farms. California mastitis test (CMT) and bacteriological culture methods were used as diagnostic tools. From 262 cows examined, 105 (40.1%) and from 1048 quarters examined, 170 (16.1%) were positive for sub-clinical mastitis using CMT. All CMT positive samples were cultured for etiological agent identification. From 170 samples cultured, 153 were positive for known subclinical mastitis pathogens. The dominant bacteria isolated were Staphylococcus species from these Staphylococcus aureus (44.9%) was the major one followed by Streptococcus spp. (25.3%) and other gram negative enteric bacteria, Escherichia coli (8.8%). Age, body condition score, milk yield, and number of parity were considered as potential risk factors; among these, age and number of parity have statistically significance association with the occurrence of subclinical mastitis (P < 0.05) both in the CMT and the bacteriological tests.

Self-reported menopausal symptoms, coronary artery calcification, and carotid intima-media thickness in recently menopausal women screened for the Kronos early estrogen prevention study (KEEPS).

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Wolff, Erin Foran; He, Yunxiao; Black, Dennis M; Brinton, Eliot A; Budoff, Mathew J; Cedars, Marcelle I; Hodis, Howard N; Lobo, Rogerio A; Manson, Joann E; Merriam, George R; Miller, Virginia M; Naftolin, Fredrick; Pal, Lubna; Santoro, Nanette; Zhang, Heping; Harman, S Mitchell; Taylor, Hugh S

2013-04-01

To determine whether self-reported menopausal symptoms are associated with measures of subclinical atherosclerosis. Cross-sectional analysis. Multicenter, randomized controlled trial. Recently menopausal women (n = 868) screened for the Kronos Early Estrogen Prevention Study (KEEPS). None. Baseline menopausal symptoms (hot flashes, dyspareunia, vaginal dryness, night sweats, palpitations, mood swings, depression, insomnia, irritability), serum E2 levels, and measures of atherosclerosis were assessed. Atherosclerosis was quantified using coronary artery calcium (CAC) Agatston scores (n = 771) and carotid intima-media thickness (CIMT). Logistic regression model of menopausal symptoms and E2 was used to predict CAC. Linear regression model of menopausal symptoms and E2 was used to predict CIMT. Correlation between length of time in menopause with menopausal symptoms, E2, CAC, and CIMT were assessed. In early menopausal women screened for KEEPS, neither E2 nor climacteric symptoms predicted the extent of subclinical atherosclerosis. Palpitations and depression approached significance as predictors of CAC. Other symptoms of insomnia, irritability, dyspareunia, hot flashes, mood swings, night sweats, and vaginal dryness were not associated with CAC. Women with significantly elevated CAC scores were excluded from further participation in KEEPS; in women meeting inclusion criteria, neither baseline menopausal symptoms nor E2 predicted CIMT. Years since menopause onset correlated with CIMT, dyspareunia, vaginal dryness, and E2. Self-reported symptoms in recently menopausal women are not strong predictors of subclinical atherosclerosis. Continued follow-up of this population will be performed to determine whether baseline or persistent symptoms in the early menopause are associated with progression of cardiovascular disease. NCT00154180. Published by Elsevier Inc.

Severity of coronary artery disease in obese patients undergoing coronary angiography

International Nuclear Information System (INIS)

Javed, A.; Ali, J.; Kayani, A.M.

2012-01-01

Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

Serum cholesterol and triglyceride concentrations in diabetic patients with subclinical hypothyroidism.

Science.gov (United States)

Díez, Juan J; Iglesias, Pedro

2014-10-01

To assess whether subclinical hypothyroidism is associated to elevations in serum cholesterol and triglyceride levels in patients with type 2 diabetes. From a total population of 1,112 patients with type 2 diabetes screened for thyroid dysfunction (thyrotropin measurement), a group of 325 patients with normal thyroid function and another group of 29 patients with subclinical hypothyroidism were selected. No patient had known dyslipidemia or was taking lipid lowering medication. Patients with subclinical hypothyroidism had serum levels of total cholesterol (4.88 ± 0.74 mmol/L), HDL cholesterol (1.37 ± 0.34 mmol/L), LDL cholesterol (2.94 ± 0.58 mmol/L), and triglycerides (1.05 [0.88-1.41] mmol/L) that did not significantly differ from those found in euthyroid patients (4.79 ± 0.83, 1.33 ± 0.36, 2.87 ± 0.76, and 1.11 [0.81-1.43] mmol/L, respectively). Multiple regression analysis showed no association between TSH and serum lipid levels. These results suggest that, in our population, there are no significant differences in serum cholesterol and triglyceride levels between diabetic patients with normal and reduced thyroid function. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

Directory of Open Access Journals (Sweden)

Jayanth Koneru

2011-01-01

Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

Subclinical Endometritis Diagnosed through Cytobrush and Reproductive Performance in Cattle from the Municipality of Pupiales, Colombia

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Darío Antonio Vallejo Timarán

2014-06-01

Full Text Available Objective: To determine the distribution of subclinical endometritis and the reproductive behavior of dairy cattle diagnosed through endometrial cytology from the Municipality of Pupiales, Nariño. Materials and methods: A reproductive assessment was carried out (rectal palpation, ultrasonography and evaluation of vaginal mucus to determine the absence of early gestation and of clinical signs of uterine infection, and 174 cows were sampled through cervical catheterization and the technique of Cytobrush starting 30 days after birth. Consequently, the population under study was organized based on ovarian function (empty cycling normal or anestrous and the status of the uterus (with or without endometritis. Results: 43 cows (24.7% showed cellular changes indicative of an active inflammatory process originated in the endometrium. 79.06% of the animals diagnosed with subclinical endometritis were cyclic and had low reproductive performance. Conclusion: The high impact of subclinical endometritis in fertility and reproductive efficiency was determined. An early reproductive assessment must be performed, together with tests that make it possible to determine the presence of concomitant subclinical conditions.

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

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.

Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

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Beganu Elena

2017-09-01

Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

Malondialdehyde level and some enzymatic activities in subclinical ...

African Journals Online (AJOL)

The purpose of this study was to evaluate the changes occurring in milk malondialdehyde (MDA) level and some enzymatic activities as a result of subclinical mastitis (SCM) in dairy cows. A total of 124 milk samples were collected from 124 lactating cows from the same herd in the period between the 2nd week after calving ...

Analysis of associations between major histocompatibility complex (BoLA) class I haplotypes and subclinical mastitis of dairy cows

DEFF Research Database (Denmark)

Aarestrup, Frank Møller; Jensen, N. E.; Østergård, H.

1995-01-01

The associations between BoLA class I haplotypes and subclinical mastitis were investigated using information on 333 cows from three different breeds and crossbreeds from 14 dairy herds in Denmark. Somatic cell count and bacteriological status were used as markers for subclinical mastitis....... Associations between BoLA class I haplotypes and IMI status were also determined. The association between BoLA class I haplotypes and subclinical mastitis was weak. The A10(W50), A11, A12(A30), A16, A19(A6), A21, A26, and A31(A30) alleles were associated with different markers of subclinical mastitis....... Susceptibility or resistance to the two bacteria categories was associated with different alleles. This study indicated that BoLA antigens may be involved in resistance to mastitis and that resistance may be specific for a particular pathogen....

Factors influencing delay time and coronary arterial density during coronary angiography with DSCT

International Nuclear Information System (INIS)

Lijun Tang; Xiaomei Zhu; Yi Xu; Tongfu Yu; Hai Xu; Jinhua Tang; Dehang Wang; Dogra, Vikram

2011-01-01

Background: CT angiography (CTA) plays an important role in diagnosing coronary arterial disease. Delay time and density of the coronary arteries related with patient-specific factors are essential for getting an optimal CTA image. Purpose: To investigate various factors influencing delay time and coronary arterial density during coronary CTA with dual source CT. Material and Methods: One hundred and sixteen consecutive subjects who underwent cardiac DSCT with retrospective ECG-gating were included. Factors including gender, age, height, weight, transversal cardiac diameter (TCD), transversal thoracic diameter (TTD), heart rate (HR), body surface area (BSA = [weight x height/3600]1/2) and cardiothoracic ratio (CTR = TCD/TTD) were recorded, measured and calculated before administration of contrast media during coronary CT angiography. Delay time was determined as duration from the beginning of the injection to the density in the descending aorta at the level of right main pulmonary artery reaching a threshold of 100 HU. Coronary arterial density was measured at the mid portion of the right coronary artery. Regression analysis and stepwise regression analysis were used to investigate the influence of these factors on delay time and coronary arterial density. Results: Delay time decreased with an increasing HR and it was shorter in women than men. Delay time increased with an increasing TCD. Delay time could be predicted by the formula: DT = 16.651-0.110 x HR + 1.902 x gender + 0.394 x TCD (where DT is abbreviation for delay time, gender is 0 for women and 1 for men). Coronary arterial density decreased with an increasing HR and weight. Coronary arterial density could be predicted by the formula: CAD = 923.42-4.099 x HR-3.293 x weight (CAD = coronary arterial density). There was no relationship between the other factors mentioned above and delay time or coronary arterial density. Conclusion: Delay time is influenced by HR, gender and TCD. Coronary arterial density

Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

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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.

[Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures].

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Fantidis, P; Fernández Ruiz, M A; Madero Jarabo, R; Moreno Granados, F; Cordovilla Zurdo, G; Sanz Galeote, E

1990-11-01

In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

Long-Term Outcome in Levothyroxine Treated Patients With Subclinical Hypothyroidism and Concomitant Heart Disease.

Science.gov (United States)

Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Kristensen, Søren Lund; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar H; Selmer, Christian

2016-11-01

Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function. This study sought to examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease. This was a register-based historical cohort study. The study was composed of Danish primary care patients and hospital outpatients age 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997-2011. Patients were stratified according to whether they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multivariable Poisson regression models. Measures included all-cause mortality and major adverse cardiac events (MACEs), defined as cardiovascular death, fatal or nonfatal myocardial infaction and stroke, and all-cause hospital admissions. Of 61 611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] y, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 y (interquartile range, 6.5 y), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR, 1.17; 95% confidence interval [CI], 0.90-1.52), MACE (adjusted IRR, 1.08; 95% CI, 0.80-1.45), or hospital admission (adjusted IRR, 0.94; 95% CI, 0.71-1.24), when compared with patients not treated with levothyroxine. Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE, or hospital admission in this large real-world cohort study.

Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance

NARCIS (Netherlands)

Wiersinga, W. M.

1995-01-01

Subclinical hypothyroidism has a prevalence of approx. 6% in the general population; it is more common in females and in the elderly. The incidence of progression to overt hypothyroidism is 5-15% per year; women with positive thyroid antibodies are especially at risk. The biological significance

A review on cardiovascular diseases originated from subclinical hypothyroidism.

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Mansourian, Azad Reza

2012-01-15

Thyroid hormones play an important role on the cardiovascular systems and thyroid disorder ultimately have a profound adverse effects on myocardium and vascular functions. There are extensive reports on the role of overt thyroid dysfunction which adversely can modify the cardiovascular metabolism but even at the present of some controversial reports, the subclinical thyroid disorders are able also to manipulate cardiovascular system to some extent. The aim of this study is to review the cardiovascular disorders accompanied with subclinical hypothyroidism. It is concluded that adverse effect of thyroid malfunction on myocardium and vascular organs are through the direct role of thyroid hormone and dyslipidemia on heart muscle cells at nuclear level and vascular system, respectively. It seems many cardiovascular disorders initially would not have been occurred in the first place if the thyroid of affected person had functioned properly, therefore thyroid function tests should be one of a prior laboratory examinations in cardiovascular disorders.

Subclinical chronic kidney disease modifies the diagnosis of experimental acute kidney injury.

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Succar, Lena; Pianta, Timothy J; Davidson, Trent; Pickering, John W; Endre, Zoltán H

2017-09-01

Extensive structural damage within the kidney must be present before serum creatinine increases. However, a subclinical phase of chronic kidney disease (CKD) usually goes undetected. Here we tested whether experimental subclinical CKD would modify functional and damage biomarker profiles of acute kidney injury (AKI). Subclinical CKD was induced in rats by adenine or aristolochic acid models but without increasing serum creatinine. After prolonged recovery (three to six weeks), AKI was induced with a subnephrotoxic dose of cisplatin. Urinary levels of kidney injury molecule-1 (KIM-1), cytochrome C, monocyte chemotactic protein-1 (MCP-1), clusterin, and interleukin-18 increased during CKD induction, without an increase in serum creatinine. After AKI in adenine-induced CKD, serum creatinine increased more rapidly, while increased urinary KIM-1, clusterin, and MCP-1 were delayed and reduced. Increased serum creatinine and biomarker excretion were associated with diffuse tubulointerstitial injury in the outer stripe of outer medulla coupled with over 50% cortical damage. Following AKI in aristolochic acid-induced CKD, increased serum creatinine, urinary KIM-1, clusterin, MCP-1, cytochrome C, and interleukin-18 concentrations and excretion were greater at day 21 than day 42 and inversely correlated with cortical injury. Subclinical CKD modified functional and damage biomarker profiles in diametrically opposite ways. Functional biomarker profiles were more sensitive, while damage biomarker diagnostic thresholds and increases were diminished and delayed. Damage biomarker concentrations and excretion were inversely linked to the extent of prior cortical damage. Thus, thresholds for AKI biomarkers may need to be lower or sampling delayed in the known presence of CKD. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Three-Dimensional Respiratory-Gated Coronary Mr Angiography with Reference to X-Ray Coronary Angiography

International Nuclear Information System (INIS)

Ikonen, A. E. J.; Manninen, H. I.; Vainio, P.; Vanninen, R. L.; Matsi, P. J.; Soimakallio, S.; Hirvonen, T.P.J.; Hartikainen, J.E.K.

2003-01-01

Purpose: To assess the clinical value of three-dimensional coronary MR angiography (CMRA) in the detection of significant coronary artery stenosis using conventional X-ray angiography as the standard reference. Material and Methods: Sixty-nine patients underwent X-ray coronary angiography and CMRA because of suspected or previously diagnosed coronary artery disease. MRI was performed with a 1.5-T whole body imaging system using ECG-triggered 3D gradient echo sequence with retrospective navigator echo respiratory gating and fat suppression. Results: A total of 276 coronary artery segments were analyzed. The X-ray coronary angiography was normal in 22 patients. Significant proximal stenoses (exceeding 50%) or occlusions were present in 102 coronary artery segments. In all, 120 stenoses or occlusions were identified in CMRA. Sixteen percent of the coronary artery segments had to be excluded because of poor image quality. The overall sensitivity and specificity for MRA for identification of significant stenosis were 75% and 62%, respectively. CMRA correctly detected 89% of patients with at least one vessel disease, but 6 patients with coronary artery disease would have been missed. Conclusions: Because of the high data exclusion and false-negative case rate, CMRA with retrospective navigator echo triggering is at present not suitable as a clinical screening method in coronary artery disease

Coronary artery anomalies in adults: imaging at dual source CT coronary angiography

International Nuclear Information System (INIS)

Laspas, Fotios; Roussakis, Arkadios; Mourmouris, Christos; Kritikos, Nikolaos; Efthimiadou, Roxani; Andreou, John

2013-01-01

Congenital abnormalities of the coronary arteries have an incidence of 1%, and most of these are benign. However, a small number are associated with myocardial ischaemia and sudden death. Various imaging modalities are available for coronary artery assessment. Recently, multi-detector CT has emerged as an accurate diagnostic tool for defining coronary artery anomalies. The purpose of this pictorial essay is to review the dual source CT appearance of congenital anomalies of the coronary arteries in adults.

Efficacy of an indicated intervention program for Indian adolescents with subclinical depression.

Science.gov (United States)

Singhal, Meghna; Munivenkatappa, Manjula; Kommu, John Vijay Sagar; Philip, Mariamma

2018-03-01

Subclinical depressive symptoms in adolescents are associated with a host of impairments and constitute a risk factor for future depression. The aim of the present study was to study the efficacy of a school-based group coping skills program for Indian adolescents with subclinical depression. Adolescents (n = 120) across two schools comprised the intervention and control groups and were assessed at baseline, post-intervention, and 3 months no-contact follow-up. The intervention group adolescents received the 8-weekly Coping Skills program in same-gender groups of 4-8 adolescents each, and the control group adolescents received one interactive psycho-educatory session. The intervention group evidenced clinically significant reductions in depressive symptoms, negative cognitions, and academic stress, and increased social problem solving and coping skills, at both post-intervention and follow-up. With regard to moderators, initial levels of depressive symptoms and homework compliance were found to partially moderate the effect of intervention. No effects were found for parental depression, gender, and age. The present study calls for future development and implementation of programs to address subclinical psychopathology among adolescents in Indian schools. Copyright © 2018 Elsevier B.V. All rights reserved.

Association of egg consumption and calcified atherosclerotic plaque in the coronary arteries: the NHLBI Family Heart Study.

Science.gov (United States)

Robbins, Jeremy M; Petrone, Andrew B; Ellison, R Curtis; Hunt, Steven C; Carr, J Jeffrey; Heiss, Gerardo; Arnett, Donna K; Gaziano, J Michael; Djoussé, Luc

2014-06-01

Eggs are a ubiquitous and important source of dietary cholesterol and nutrients, yet their relationship to coronary heart disease (CHD) remains unclear. While some data have suggested a positive association between egg consumption and CHD, especially among diabetic subjects, limited data exist on the influence of egg consumption on subclinical disease. Thus, we sought to examine whether egg consumption is associated with calcified atherosclerotic plaques in the coronary arteries. In a cross-sectional design, we studied 1848 participants of the NHLBI Family Heart Study without known CHD. Egg consumption was assessed by a semi-quantitative food frequency questionnaire and coronary-artery calcium (CAC) was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Mean age was 56.5 years and 41% were male. Median consumption of eggs was 1/week. There was no association between frequency of egg consumption and prevalent CAC. Odds ratios (95% CI) for CAC were 1.0 (reference), 0.95 (0.66-1.38), 0.94 (0.63-1.40), and 0.90 (0.57-1.42) for egg consumption of almost never, 1-3 times per month, once per week, and 2+ times per week, respectively (p for trend 0.66), adjusting for age, sex, BMI, smoking, alcohol, physical activity, income, field center, total calories, and bacon. Additional control for hypertension and diabetes mellitus, or restricting the analysis to subjects with diabetes mellitus or fasting glucose >126 mg/dL did not alter the findings. These data do not provide evidence for an association between egg consumption and prevalent CAC in adult men and women.

The value of coronary artery calcium score assessed by dual-source computed tomography coronary angiography for predicting presence and severity of coronary artery disease

International Nuclear Information System (INIS)

Almasi, Alireza; Pouraliakbar, Hamidreza; Sedghian, Ahmad; Karimi, Mohammad Ali; Firouzi, Ata; Tehrai, Mahmood

2014-01-01

Measuring coronary artery calcium score (CACS) using a dual-source CT scanner is recognized as a major indicator for assessing coronary artery disease. The present study aimed to validate the clinical significance of CACS in predicting coronary artery stenosis and its severity. This prospective study was conducted on 202 consecutive patients who underwent both conventional coronary angiography and dual-source (256-slice) computed tomography coronary angiography (CTA) for any reason in our cardiac imaging center from March to September 2013. CACS was measured by Agatston algorithm on non-enhanced CT. The severity of coronary artery disease was assessed by Gensini score on conventional angiography. There was a significant relationship between the number of diseased coronary vessels and mean calcium score, i.e. the mean calcium score was 202.25±450.06 in normal coronary status, 427.50±607.24 in single-vessel disease, 590.03±511.34 in two-vessel disease, and 953.35±1023.45 in three-vessel disease (p<0.001). There was a positive association between calcium score and Gensini score (r=0.636, p<0.001). In a linear regression model, calcium score was a strong determinant of the severity of coronary artery disease. Calcium scoring had an acceptable value for discriminating coronary disease from normal condition with optimal cutoff point of 350, yielding a sensitivity and specificity of 83% and 70%, respectively. Our study confirmed the strong relationship between the coronary artery calcium score and the presence and severity of stenosis in coronary arteries assessed by both the number of diseased coronary vessels and also by the Gnesini score

Subclinical Hyperthyroidism-A Cohort Study

International Nuclear Information System (INIS)

Hashim, R.; Anwer, M. S.; Khan, F. A.; Ijaz, A.

2013-01-01

Objective: To compare the development of overt hyperthyroidism in a cohort of patients of subclinical hyperthyroidism (SCR) and in subjects with normal thyroid function tests. Study Design: A cohort study. Place and Duration of study: The study was conducted in the department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from Sept 2006 to Sept 2007. Patients and Methods: Fifty patients of SCR and almost equal number of age and sex-matched subjects with normal Thyroid function test (TFT) were included in the study as controls. Subclinical hyperthyroid patients and controls were followed for a period of one year on a six monthly basis. The patients were examined for signs and symptoms of hyperthyroidism and serum TSH, total T3 and free T4 were estimated. The clinical history, physical examination and TFT results were recorded. Five ml of blood was collected for serum thyroid profile in plain tube. Hormonal analysis(TSH, T4 and T3) was done for the patients and the controls enrolled in the study. The TFTs was analyzed using Chemiluminescence Immunoassay technique on Immulite 2000 an automated, random access, immunoassay analyzer. Results: Six (12%) out of 50 cases of the SCR patients and 2 (4%) out of 50 controls developed overt hyperthyroidism. SCR had no significant risk for conversion to overt hyperthyroidism as compared to healthy controls in this study. In addition to initial levels of serum TSH were one of important predictor for conversion of SCR to overt hyperthyroidism. Conclusion: Patients with SCR have no significant risk but showed an increase in frequency of conversion to overt hyperthyroidism (12% in this study) as compared to controls. (author)

Subclinical hypothyroidism, mood, and cognition in older adults: a review.

Science.gov (United States)

Joffe, Russell T; Pearce, Elizabeth N; Hennessey, James V; Ryan, Joseph J; Stern, Robert A

2013-02-01

To perform a critical review of the literature on the mood and cognitive changes associated with subclinical hypothyroidism (SCH), with an emphasis on older adults. To evaluate these data against the Consensus Statement on the management of SCH from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. A comprehensive literature review. Subclinical hypothyroidism may be associated with an increased risk of mood and cognitive dysfunction, although the strength of this association and the efficacy of replacement hormone therapy require further investigation. It remains unclear whether SCH leads to significant mood and cognitive impairments in most older patients. More research is required to determine the nature and extent of this association and whether thyroid hormone replacement therapy is appropriate and effective in treating SCH-associated neurobehavioral impairments. Copyright © 2012 John Wiley & Sons, Ltd.

Comparison of high-sensitivity C-reactive protein and fetuin-A levels before and after treatment for subjects with subclinical hyperthyroidism.

Science.gov (United States)

Bilgir, Oktay; Bilgir, Ferda; Topcuoglu, Tuba; Calan, Mehmet; Calan, Ozlem

2014-03-01

This study was designed to show the effect of propylthiouracil treatment on sCD40L, high-sensitivity C-reactive protein, and fetuin-A levels on subjects with subclinical hyperthyroidism. After checking sCD40L, high-sensitivity C-reactive protein, and fetuin-A levels of 35 patients with subclinical hyperthyroidism, each was given 50 mg tablets of propylthiouracil three times daily. After 3 months, sCD40L, high-sensitivity C-reactive protein, and fetuin-A levels were then compared to the levels before treatment. Although high-sensitivity C-reactive protein and sCD40L levels were normal in the subclinical hyperthyroidism patients compared to the healthy controls, fetuin-A levels were statistically significantly higher (*p = 0.022). After treatment, fetuin-A levels of subclinical hyperthyroidism patients decreased statistically significantly compared to the levels before treatment (**p = 0.026). sCD40L and high-sensitivity C-reactive protein levels did not have a statistically significant difference compared to the control group and post-propylthiouracil treatment. In subclinical hyperthyroidism patients, high fetuin-A levels before propylthiouracil treatment and decreases in these levels after treatment in cases with subclinical hyperthyroidism indicated the possibility of preventing long-term cardiac complications with propylthiouracil treatment.

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.

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

Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

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Xiangfei Wang

2014-01-01

Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

Is there an independent effect of polycystic ovary syndrome (PCOS) and menopause on the prevalence of subclinical atherosclerosis in middle aged women?

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Talbott, Evelyn O; Zborowski, Jeanne; Rager, Judy; Stragand, Juley R

2008-01-01

Polycystic ovary syndrome (PCOS), a common reproductive endocrine condition manifests at puberty, and is characterized by hyperandrogenism, chronic anovulation, and obesity. PCOS cases exhibit an adverse coronary heart disease (CHD) profile at an early age, including insulin resistance, dyslipidemia and increased central adiposity. It can be hypothesized that the menopausal transition, whether natural or surgical, may provide an additional "insult", resulting in greater cumulative risk to their vasculature. Coronary artery calcification (CAC), a measure of subclinical atherosclerosis (SCA), was measured by electron beam tomography in 149 PCOS cases and 166 controls (mean age 47.3 and 49.4 respectively). Cases had a higher prevalence of CAC (63.1%) compared to controls (41.0%), (p = 0.037) after adjustment for age and BMI. A total of 22 cases and 39 controls had undergone natural menopause, 12 cases and 26 controls underwent surgical menopause (with biochemical confirmation) and 115 cases and 101 controls reported being currently premenopausal. There was a significant difference in CAC values between cases and controls in all three-menopause categories including pre-menopausal, surgically induced and natural menopause (p 10) as the dependent variable, and independent variables: PCOS status, current age, BMI, and menopausal status, (pre-menopause, surgical and natural menopause) and selected CHD risk factors. The data indicate that women with PCOS exhibit significantly increased CAC compared to controls after adjustment for age and BMI and menopausal status. PCOS status and fasting glucose were significant risk factors for CAC (p PCOS status continues to affect cardiovascular risk as they undergo the menopausal transition.

Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

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Mette Nygaard Andersen

Full Text Available Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI, cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism.Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9% had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female. Within the first six months 2,483 (20.3% patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2 years, 358 MI's and 1,566 (12.8% deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44], cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25] or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19], except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99].Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

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Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

2015-01-01

Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI's and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

Structural brain abnormalities in women with subclinical depression, as revealed by voxel-based morphometry and diffusion tensor imaging.

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Hayakawa, Yayoi K; Sasaki, Hiroki; Takao, Hidemasa; Mori, Harushi; Hayashi, Naoto; Kunimatsu, Akira; Aoki, Shigeki; Ohtomo, Kuni

2013-01-25

Brain structural changes accompany major depressive disorder, but whether subclinical depression is accompanied by similar changes in brain volume and white matter integrity is unknown. By using voxel-based morphometry (VBM) of the gray matter and tract-specific analysis based on diffusion tensor imaging (DTI) of the white matter, we explored the extent to which abnormalities could be identified in specific brain structures of healthy adults with subclinical depression. The subjects were 21 community-dwelling adults with subclinical depression, as measured by their Center for Epidemiologic Studies Depression Scale (CES-D) scores. They were not demented and had no neurological or psychiatric history. We collected brain magnetic resonance images of the patients and of 21 matched control subjects, and we used VBM to analyze the differences in regional gray matter volume between the two groups. Moreover, we examined the white matter integrity by using tract-specific analysis based on the gray matter volume changes revealed by VBM. VBM revealed that the volumes of both anterior cingulate gyri and the right rectal gyrus were smaller in subclinically depressed women than in control women. Calculation of DTI measures in the anterior cingulum bundle revealed a positive correlation between CES-D scale score and radial diffusivity in the right anterior cingulum in subclinically depressed women. The small sample size limits the stability of the reported findings. Gray matter volume reduction and white matter integrity change in specific frontal brain regions may be associated with depressive symptoms in women, even at a subclinical level. Copyright © 2012 Elsevier B.V. All rights reserved.

Sleep quality and cognitive function in healthy old age: the moderating role of subclinical depression.

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Sutter, Christine; Zöllig, Jacqueline; Allemand, Mathias; Martin, Mike

2012-11-01

Previous research has yielded inconclusive results on the relationship between self-reported sleep quality and cognitive performance in healthy old age. Discrepant findings have been reported regarding processing speed and attention, executive functions, and episodic memory. However, sleep quality has also been found to be related to cognitive performance in patients with depression. Our aim was to clarify the relationship between sleep quality and cognitive performance in healthy older adults, and to evaluate the moderating role of subclinical depression on this relationship. The Pittsburgh Sleep Quality Index was used to assess subjective sleep quality in 107 participants (age ≥ 61 years). A broad battery of neuropsychological tests measured basic cognitive processes, executive functions, and memory processes. Subclinical depression moderated the link between sleep quality and cognitive performance. More precisely, poorer sleep quality was associated with lower performance in reasoning, semantic fluency, and shifting in those with high versus low levels of subclinical depression. Our findings suggest that poor sleep quality might affect higher order cognitive processes, particularly in those reporting higher levels of subclinical depression. Findings on the relationships between sleep quality, cognitive functioning, and depressive symptomatology are discussed in relation to neurobehavioral theories of sleep. (c) 2012 APA, all rights reserved.

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.

One-year progression of diabetic subclinical macular edema in eyes with mild nonproliferative diabetic retinopathy

DEFF Research Database (Denmark)

Tejerina, Amparo Navea; Vujosevic, Stela; Varano, Monica

2015-01-01

PURPOSE: To characterize the 1-year progression of retinal thickness (RT) increase occurring in eyes with subclinical macular edema in type 2 diabetes. METHODS: Forty-eight type 2 diabetic eyes/patients with mild nonproliferative diabetic retinopathy (NPDR; levels 20 and 35 in the Early Treatment...... Diabetic Retinopathy Study) classified as presenting subclinical macular edema at baseline completed the 1-year follow-up period, from a sample of 194 followed in a 12-month observational and prospective study (ClinicalTrials.gov identifier: NCT01145599). Automated segmentation of the retinal layers...... in these eyes was performed, followed by verification and correction by a human grader. RESULTS: The highest increase in RT over the 1-year follow-up period for the 48 eyes/patients with subclinical macular edema was found in the inner nuclear layer (INL). Progression to clinical macular edema was also...

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

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

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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

[Pregnancy and coronary artery dissection].

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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.

Relationship between subclinical hypothyroidism and serum homocysteine concentration in premenopausal women

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Ayfer Aydoğdu Çolak

2013-09-01

Full Text Available Objective: In our study we aimed to examine serum homocysteinelevels of patients without thyroid dysfunctionswho have high serum anti thyroid peroxidase (anti-TPOlevels and patients with subclinical hypothyroidism whohave high serum thyroid stimulating hormone (TSH andanti-TPO levels.Methods: One hundred and seven premenopause femaleoutpatients who referred to endocrine clinic of our hospitalwere included in our study. We generated 3 groups. Firstgroup (Control consists of 53 (50% patients between theages of 30-40 years. Second group (Euthyroid consistsof 31 (29% patients between the ages of 26-49. Thirdgroup (Subclinical Hypothyroidism consists of 23 (21%patients between the ages of 33-53 years. Serum totalcholesterol, triglycerides, high density lipoprotein (HDLlevels were measured by Olympus 2700 autoanalyzer.Serum TSH, free T4, anti-TPO and homocysteine levelswere measured by Siemens Immulite 2000 autoanalyzer.Results: In our study, total cholesterol, triglycerides, lowdensity lipoprotein (LDL and very low density lipoprotein(VLDL levels were not statistically significantly differentamong the groups. Although serum homocysteine levelsof the third group were higher than the other groups it wasnot statistically significantly different among the groups.Conclusion: Serum homocysteine and lipid levels of patientswith euthyroidism and subclinical hypothyroidismwho have positive anti-TPO levels may be inadequate inassessing the risk of cardiovascular diseases. J Clin ExpInvest 2013; 4 (3: 293-297Key words: Hypothyroidsm, homocysteine, premenopause

RELATIONSHIP BETWEEN SOME BIOCHEMICAL PARAMETERS IN HEALTHY AND DAIRY COWS WITH SUBCLINICAL KETOSIS

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Gülşah Akgül

2017-07-01

Full Text Available The aim of the presented study is to compare beta-hydroxy butyric acid (BHBA, glucose (GLU gamma-glutamyl transferase (GGT, phosphorus (P, calcium (Ca, and albumin (Alb values of healthy animals and animals suffering from subclinical ketosis. The material in this study consisted of 15 healthy cows and 15 cows with subclinical ketosis on a commercial dairy farm located in Bursa (Turkey. Significant differences (p<0.001 were observed in BHBA, GLU, and Ca between the two groups. Results of this study might indicate the importance of calcium metabolism in the pathogenesis of the disease.

Subclinical hyperthyroidism due to a thyrotropin receptor (TSHR) gene mutation (S505R).

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Pohlenz, Joachim; Pfarr, Nicole; Krüger, Silvia; Hesse, Volker

2006-12-01

To identify the molecular defect by which non-autoimmune subclinical hyperthyroidism was caused in a 6-mo-old infant who presented with weight loss. Congenital non-autoimmune hyperthyroidism is caused by activating germline mutations in the thyrotropin receptor (TSHR) gene. Therefore, the TSHR gene was sequenced directly from the patient's genomic DNA. Molecular analysis revealed a heterozygous point mutation (S505R) in the TSHR gene as the underlying defect. A constitutively activating mutation in the TSHR gene has to be considered not only in patients with severe congenital non-autoimmune hyperthyroidism, but also in children with subclinical non-autoimmune hyperthyroidism.

Depressive and anxiety disorders and risk of subclinical atherosclerosis Findings from the Netherlands Study of Depression and Anxiety (NESDA)

NARCIS (Netherlands)

Seldenrijk, Adrie; Vogelzangs, Nicole; van Hout, Hein P. J.; van Marwijk, Harm W. J.; Diamant, Michaela; Penninx, Brenda W. J. H.

Objective: Current evidence regarding the association between psychopathology and subclinical atherosclerosis show inconsistent results. The present study examined whether subclinical atherosclerosis was more prevalent in a large cohort of persons with depressive or anxiety disorders as compared to

Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

LENUS (Irish Health Repository)

Shah, A R

2010-05-01

Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

PLACENTAL GROWTH FACTOR AND CORONARY NEOANGIOGENESIS IN CORONARY HEART DISEASE

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M. V. Tulikov

2013-01-01

Full Text Available Neoangiogenesis in coronary heart disease is a protective reaction aimed to improve ischemic myocardial perfusion, by increasing the number and size of arterial collaterals. Placental growth factor (PlGF is one of the key peptides regulating angiogenic processes in atherosclerosis. In particular, a number of investigators have shown that injection of recombinant PlGF into the system or regional blood flow can stimulate neoangiogenesis. On the other hand, there is evidence confirming the involvement of PlGF in the progression of atherosclerosis and in the development of acute coronary syndrome. In this connection, the problem of investigating the efficiency and safety of possible use of PlGF preparations, as well as its place in the diagnosis of coronary heart disease and acute coronary syndrome remains urgent

Identifying Coronary Artery Disease in Asymptomatic Middle-Aged Sportsmen: The Additional Value of Pulse Wave Velocity.

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Thijs L Braber

Full Text Available Cardiovascular screening may benefit middle-aged sportsmen, as coronary artery disease (CAD is the main cause of exercise-related sudden cardiac death. Arterial stiffness, as measured by pulse wave velocity (PWV, may help identify sportsmen with subclinical CAD. We examined the additional value of PWV measurements to traditional CAD risk factors for identifying CAD.From the Measuring Athlete's Risk of Cardiovascular events (MARC cohort of asymptomatic, middle-aged sportsmen who underwent low-dose Cardiac CT (CCT after routine sports medical examination (SME, 193 consecutive sportsmen (aged 55 ± 6.6 years were included with additional PWV measurements before CCT. Sensitivity, specificity and predictive values of PWV values (>8.3 and >7.5 m/s assessed by Arteriograph were used to identify CAD (coronary artery calcium scoring ≥ 100 Agatston Units or coronary CT angiography luminal stenosis ≥ 50% and to assess the additional diagnostic value of PWV to established cardiovascular risk factors.Forty-seven sportsmen (24% had CAD on CCT. They were older (58.9 vs. 53.8 years, p8.3m/s respectively >7.5 m/s sensitivity to detect CAD on CT was 43% and 74%, specificity 69% and 45%, positive predictive value 31% and 30%, and negative predictive value 79% and 84%. Adding PWV to traditional risk factor models did not change the area under the curve (from 0.78 (95% CI = 0.709-0.848 to AUC 0.78 (95% CI 0.710-0.848, p = 0.99 for prediction of CAD on CCT.Limited additional value was found for PWV on top of established risk factors to identify CAD. PWV might still have a role to identify CAD in middle-aged sportsmen if risk factors such as cholesterol are unknown.

The influence of radioiodine therapy in 1470 patients with subclinical hyperthyroidism

International Nuclear Information System (INIS)

Abdelrazek, S.; Szumowski, P.; Mysliwiec, J.; Mojsak, M.; Kraszynska, A.; Amelian-Filonowicz, A.

2015-01-01

Full text of publication follows. The aim of our study was to assess the influence of radioiodine ( 131 I) therapy on the achievement of euthyroidism, prevention of adverse effects on the cardiovascular and prevent evolvement to overt hyperthyroidism. Material and methods: we treated 1470 patients sent to our department during the last 7 years, aged 24-76 years; 88% of them were female and 12% male; 490 patients with multi-nodular goitre (MNG), and 980 patients with autonomous nodule (ATN). Some of the patients were treated with antithyroid drugs for 1 to 3 months before 131 I therapy (140 patients). Malignant changes were excluded in all nodules by fine needle aspiration biopsy. All the patients had serum TSH levels <0.1 mU/l and effective T-half was more than 3 days at the time of treatment. The activity dose was calculated by the use of Marinelli's formula and ranged between 200 and 800 MBq. The absorbed dose (Gy) ranged between 180 and 300, and was proportional to thyroid volume. Follow up control was done every 6 weeks. Results: euthyroidism achieved in 99% of patient with ATN and 94% of MNG; 1% of patients with ATN and 5% of patients with MNG develop hypothyroidism. 1% of patients with MNG were in subclinical hyperthyroidism and received second dose of radioiodine therapy. In all of the patients, the symptoms and signs of subclinical hyperthyroidism disappeared (palpitation, tachycardia, atrial fibrillation, exercise tolerance improved, the blood pressure normalised and the quality of life improved). Conclusions: our result is good and is in the range of the existing literature. The achievement of euthyroidism and the remission of the symptoms and signs of subclinical hyperthyroidism, were due to good diagnosis, well preparation of the patients; accurate measurement of administered activity, effective half-life, and well-organised follow up. We recommend early treatment of subclinical hyperthyroidism, and long period of follow up visits in our department

[Development of an automated processing method to detect coronary motion for coronary magnetic resonance angiography].

Science.gov (United States)

Asou, Hiroya; Imada, N; Sato, T

2010-06-20

On coronary MR angiography (CMRA), cardiac motions worsen the image quality. To improve the image quality, detection of cardiac especially for individual coronary motion is very important. Usually, scan delay and duration were determined manually by the operator. We developed a new evaluation method to calculate static time of individual coronary artery. At first, coronary cine MRI was taken at the level of about 3 cm below the aortic valve (80 images/R-R). Chronological change of the signals were evaluated with Fourier transformation of each pixel of the images were done. Noise reduction with subtraction process and extraction process were done. To extract higher motion such as coronary arteries, morphological filter process and labeling process were added. Using these imaging processes, individual coronary motion was extracted and individual coronary static time was calculated automatically. We compared the images with ordinary manual method and new automated method in 10 healthy volunteers. Coronary static times were calculated with our method. Calculated coronary static time was shorter than that of ordinary manual method. And scan time became about 10% longer than that of ordinary method. Image qualities were improved in our method. Our automated detection method for coronary static time with chronological Fourier transformation has a potential to improve the image quality of CMRA and easy processing.

Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

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Ali Kemal Gür

2013-12-01

Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

Quality of life in longterm exogenous subclinical hyperthyroidism and the effects of restoration of euthyroidism, a randomized controlled trial

NARCIS (Netherlands)

Eustatia-Rutten, C. F. A.; Corssmit, E. P. M.; Pereira, A. M.; Frölich, M.; Bax, J. J.; Romijn, J. A.; Smit, J. W. A.

2006-01-01

The impact of prolonged subclinical hyperthyroidism on quality of life is unclear. Therefore, we evaluated quality of life in patients with differentiated thyroid carcinoma (DTC) on TSH-suppressive thyroxine therapy as a model for subclinical hyperthyroidism and we investigated whether restoration

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

Acute phase proteins in the diagnosis of bovine subclinical mastitis.

Science.gov (United States)

Safi, Shahabeddin; Khoshvaghti, Ameneh; Jafarzadeh, Seyed Reza; Bolourchi, Mahmoud; Nowrouzian, Iradj

2009-12-01

The California mastitis test (CMT) and somatic cell count (SCC) are commonly used for diagnosis of subclinical mastitis in cattle. Acute phase proteins (APPs), as alternative biomarkers of mastitis, may increase in concentration in the absence of macroscopic changes in the milk, or may precede the onset of clinical signs. The aim of this study was to compare the accuracy of APPs measured in milk and in serum with bacterial culture for the diagnosis of bovine subclinical mastitis. One hundred and seventy-five Holstein cows were randomly selected from 7 dairy farms. Quarter milk and serum samples were taken from all cows. Milk samples were analyzed using a CMT and SCC, and for haptoglobin (MHp) and amyloid A (MAA) concentrations, and were also submitted for bacterial culture. Serum samples obtained concurrently were analyzed for haptoglobin (SHp) and amyloid A (SAA). Two-sample Wilcoxon (Mann-Whitney) test was used to compare SCC, MAA, MHp, SAA, and SHp concentrations between culture-positive and culture-negative animals. Receiver-operating characteristic analysis was used to assess the performance of each test using bacterial culture as the reference method. MAA concentration was the most accurate of the 5 tests, with a sensitivity of 90.6% and specificity of 98.3% at concentrations >16.4 mg/L. MAA and MHp had significantly larger areas under the curve than the respective serum proteins, SAA and SHp. The results suggest that measuring haptoglobin and amyloid A in milk is more accurate than serum analysis for the diagnosis of subclinical mastitis in Holstein cows.

Sympathovagal response to orthostatism in overt and in subclinical hyperthyroidism.

Science.gov (United States)

Goichot, B; Brandenberger, G; Vinzio, S; Perrin, A E; Geny, B; Schlienger, J L; Simon, C

2004-04-01

Heart rate variability (HRV) is a measure of the physiological variation of R-R intervals, reflecting the sympathovagal balance. In both overt and subclinical hyperthyroidism, a relative increase in sympathetic activity has been demonstrated, mainly due to a decrease in vagal activity. The modifications of HRV during orthostatism in normal subjects resemble those seen in hyperthyroidism. We have studied the response of 19 patients with overt hyperthyroidism and 12 with subclinical hyperthyroidism during orthostatism using HRV and compared the results to those of 32 healthy controls. In the three groups, the R-R intervals decreased in the same proportion after orthostatism. The low frequency power (LF)/[LF + high frequency power (HF)] ratio, which reflects the sympathetic tone, also increased in the same proportion in the three groups. However, the mechanisms of the modulation of the sympathovagal balance during orthostatism were different among the three groups. In controls, the relative increase of sympathetic tone after orthostatism was due principally to a decrease in vagal tone (reflected by decreased power in the HF band), while in overt hyperthyroidism, where the power in the HF band was already minimal in the lying position, there was a clear increase in the LF band power during orthostatism. The results were intermediate in the subclinical hyperthyroidism group, reflecting a continuum of effects of the thyroid hormone excess on the autonomic nervous system. Our study shows that despite an apparent normal cardiovascular adaptation to orthostatism in hyperthyroidism, the modulation of the autonomic nervous system is profoundly modified.

Physiologic assessment of coronary artery fistula

Energy Technology Data Exchange (ETDEWEB)

Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

1991-01-01

Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

Physiologic assessment of coronary artery fistula

International Nuclear Information System (INIS)

Gupta, N.C.; Beauvais, J.

1991-01-01

Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery

Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

DEFF Research Database (Denmark)

Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini

2016-01-01

AIMS: Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated the association between coronary stenosis severity, plaque characteristics, coronary computed...... tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed...

Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

Science.gov (United States)

Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

2015-01-01

Background Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Methods and Results Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI’s and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Conclusion Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI. PMID:26069971

Exogenous subclinical hyperthyroidism: effect on the cardiovascular system.

Science.gov (United States)

Federico Moreno, Karol; Paoli de Valeri, Mariela; Odreman, Rodolfo; Núñez, Tulio; Arata-Bellabarba, Gabriela

2008-06-01

To evaluate the effects of exogenous subclinical hyperthyroidism on left ventricular structure and function. Twenty-three patients of both sexes, aged 27 to 70 years, with a diagnosis of exogenous subclinical hyperthyroidism (serum thyroid-stimulating hormone [TSH] ≤ 0.4mU/ml and normal free thyroxine [FT4]) were evaluated. The patients had been taking levothyroxine in suppressive doses for an average of 6.7 years (1 to 35 years). Twenty euthyroid individuals matched for age, sex and body mass index were selected as controls. A medical history was obtained and symptoms of thyrotoxicosis were quantified in all subjects. To evaluate left ventricular structure and function, as well as atrial conduction time, a two-dimensional echocardiogram and pulsed echo and tissue echo Doppler with electrocardiography monitoring were performed. The index of hemodynamic compensation of the left ventricular mass was calculated. Hyperthyroid symptom scores were significantly higher in patients than in controls (p=0.0001). A positive correlation was found between hyperthyroidism scores and FT4 (p=0.005) and ejection fraction (p=0.04) and a negative correlation was found with TSH levels (p=0.03). End-diastolic volume, stroke volume, cardiac output and stroke work were significantly higher in patients with SH (p=0.04, p=0.02, p=0.05 and p=0.01, respectively). A positive correlation was found between fractional shortening and FT4 level (p=0.022) and levothyroxine dose (p=0.016) and between stroke work and FT4 level (p=0.034). Left ventricular mass, diastolic function and atrial conduction time were similar in patients and controls. Our study suggests that patients with exogenous subclinical hyperthyroidism have hemodynamic changes resulting from adaptation to the biological effects of levothyroxine on the cardiovascular system. However, structural changes are not produced. Copyright © 2008 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights

Cost of Mastitis in Scottish Dairy Herds with Low and High Subclinical Mastitis Problems

OpenAIRE

YALÇIN, Cengiz

2000-01-01

The aim of this study was to estimate the cost of mastitis and the contribution of each cost component of mastitis to the total mastitis induced cost in herds with low and high levels of subclinical mastitis under Scottish field conditions. It was estimated that mastitis cost £140 per cow/year to the average Scottish dairy farmer in 1996. However, this figure was as low as £69 per cow/year in herds with lower levels of subclinical mastitis, and as high as £228 cow/year in herds with high s...

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 ...

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.)

Coronary artery anomalies in Turner Syndrome.

Science.gov (United States)

Viuff, Mette H; Trolle, Christian; Wen, Jan; Jensen, Jesper M; Nørgaard, Bjarne L; Gutmark, Ephraim J; Gutmark-Little, Iris; Mortensen, Kristian H; Gravholt, Claus Højbjerg; Andersen, Niels H

Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. Coronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

Bulk tank somatic cell counts analyzed by statistical process control tools to identify and monitor subclinical mastitis incidence.

Science.gov (United States)

Lukas, J M; Hawkins, D M; Kinsel, M L; Reneau, J K

2005-11-01

The objective of this study was to examine the relationship between monthly Dairy Herd Improvement (DHI) subclinical mastitis and new infection rate estimates and daily bulk tank somatic cell count (SCC) summarized by statistical process control tools. Dairy Herd Improvement Association test-day subclinical mastitis and new infection rate estimates along with daily or every other day bulk tank SCC data were collected for 12 mo of 2003 from 275 Upper Midwest dairy herds. Herds were divided into 5 herd production categories. A linear score [LNS = ln(BTSCC/100,000)/0.693147 + 3] was calculated for each individual bulk tank SCC. For both the raw SCC and the transformed data, the mean and sigma were calculated using the statistical quality control individual measurement and moving range chart procedure of Statistical Analysis System. One hundred eighty-three herds of the 275 herds from the study data set were then randomly selected and the raw (method 1) and transformed (method 2) bulk tank SCC mean and sigma were used to develop models for predicting subclinical mastitis and new infection rate estimates. Herd production category was also included in all models as 5 dummy variables. Models were validated by calculating estimates of subclinical mastitis and new infection rates for the remaining 92 herds and plotting them against observed values of each of the dependents. Only herd production category and bulk tank SCC mean were significant and remained in the final models. High R2 values (0.83 and 0.81 for methods 1 and 2, respectively) indicated a strong correlation between the bulk tank SCC and herd's subclinical mastitis prevalence. The standard errors of the estimate were 4.02 and 4.28% for methods 1 and 2, respectively, and decreased with increasing herd production. As a case study, Shewhart Individual Measurement Charts were plotted from the bulk tank SCC to identify shifts in mastitis incidence. Four of 5 charts examined signaled a change in bulk tank SCC before

Coronary stent on coronary CT angiography: Assessment with model-based iterative reconstruction technique

Energy Technology Data Exchange (ETDEWEB)

Lee, Eun Chae; Kim, Yeo Koon; Chun, Eun Ju; Choi, Sang IL [Dept. of of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2016-05-15

To assess the performance of model-based iterative reconstruction (MBIR) technique for evaluation of coronary artery stents on coronary CT angiography (CCTA). Twenty-two patients with coronary stent implantation who underwent CCTA were retrospectively enrolled for comparison of image quality between filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR) and MBIR. In each data set, image noise was measured as the standard deviation of the measured attenuation units within circular regions of interest in the ascending aorta (AA) and left main coronary artery (LM). To objectively assess the noise and blooming artifacts in coronary stent, we additionally measured the standard deviation of the measured attenuation and intra-luminal stent diameters of total 35 stents with dedicated software. All image noise measured in the AA (all p < 0.001), LM (p < 0.001, p = 0.001) and coronary stent (all p < 0.001) were significantly lower with MBIR in comparison to those with FBP or ASIR. Intraluminal stent diameter was significantly higher with MBIR, as compared with ASIR or FBP (p < 0.001, p = 0.001). MBIR can reduce image noise and blooming artifact from the stent, leading to better in-stent assessment in patients with coronary artery stent.

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...

Self-Reported Menopausal Symptoms, Coronary Artery Calcification and Carotid Intima-Media Thickness in Recently Menopausal Women Screened for the Kronos Early Estrogen Prevention Study (KEEPS)

Science.gov (United States)

Wolff, Erin Foran; He, Yunxiao; Black, Dennis M.; Brinton, Eliot A.; Budoff, Mathew J.; Cedars, Marcelle I.; Hodis, Howard N.; Lobo, Rogerio A.; Manson, JoAnn E.; Merriam, George R.; Miller, Virginia M.; Naftolin, Fredrick; Pal, Lubna; Santoro, Nanette; Zhang, Heping; Harman, S. Mitchell; Taylor, Hugh S.

2012-01-01

Objective To determine whether self-reported menopausal symptoms are associated with measures of subclinical atherosclerosis. Setting Multi-center, randomized controlled trial. Patients Recently menopausal women (n=868) screened for the Kronos Early Estrogen Prevention Study (KEEPS). Design Cross sectional analysis. Interventions None Main Outcome Measures Baseline menopausal symptoms (hot flashes, dyspareunia, vaginal dryness, night sweats, palpitations, mood swings, depression, insomnia, irritability), serum estradiol (E2) levels and measures of atherosclerosis were assessed. Atherosclerosis was quantified using Coronary Artery Calcium (CAC) Agatston scores (n=771) and Carotid Intima-Media Thickness (CIMT). Logistic regression model of menopausal symptoms and E2 was used to predict CAC. Linear regression model of menopausal symptoms and E2 was used to predict CIMT. Correlation between length of time in menopause with menopausal symptoms, estradiol (E2), CAC, and CIMT were assessed. Results In early menopausal women screened for KEEPS, neither E2 nor climacteric symptoms predicted the extent of subclinical atherosclerosis. Palpitations (p=0.09) and depression (p=0.07) approached significance as predictors of CAC. Other symptoms of insomnia, irritability, dyspareunia, hot flashes, mood swings, night sweats, and vaginal dryness were not associated with CAC. Women with significantly elevated CAC scores were excluded from further participation in KEEPS; in women meeting inclusion criteria, neither baseline menopausal symptoms nor E2 predicted CIMT. Years since menopause onset correlated with CIMT, dyspareunia, vaginal dryness and E2. Conclusions Self-reported symptoms in recently menopausal women are not strong predictors of subclinical atherosclerosis. Continued follow-up of this population will be performed to determine if baseline or persistent symptoms in the early menopause are associated with progression of cardiovascular disease. PMID:23312232

Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries

International Nuclear Information System (INIS)

Dewey, M.; Hamm, B.; Hoffmann, H.

2006-01-01

Purpose: to investigate the influence of sublingual glycerol trinitrate (1.2 mg, Nitrate [nitroglycerine], Nitrolingual N spray) on the coronary artery diameter on multislice computed tomography (MSCT) coronary angiography. Materials and methods: out of our database of patients who underwent MSCT (slice thickness of 0.5 mm, Aquilion, Toshiba) coronary angiography between July 2003 and November 2005 (950 patients) we retrospectively identified patients with follow-up examinations who received Nitrate for one examination while another examination was performed without Nitrate (10 patients). Another 10 patients who underwent two MSCT examinations with sublingual Nitrate administration were randomly selected from this database to serve as control group. For the resulting 40 MSCT examinations, blinded MSCT datasets were prepared, which were randomly evaluated by a reader blinded to the patient information and whether or not Nitrate had been given. The proximal coronary artery diameters were measured for the left main coronary artery (LMA), the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA) in all 40 datasets, resulting in altogether 160 measurements. Results: the proximal diameters of all four coronary arteries were significantly larger on the MSCT coronary angiograms obtained after sublingual administration of Nitrate compared with the examinations in the same 10 patients without Nitrate (p < 0.001). The average diameters without and with Nitrate for the LMA, LAD, LCX, and RCA were 4.3 ± 1.1 vs. 4.8 ± 0.9 mm (12% increase, p < 0.005), 3.0 ± 0.6 vs. 3.5 ± 0.5 mm (17% increase, p < 0.001), 2.7 ± 0.6 vs. 3.2 ± 0.7 mm (19% increase, p < 0.005), and 2.9 ± 0.9 vs. 3.5 ± 0.7 mm (21% increase, p < 0.005), respectively. In the control group of 10 patients who underwent two MSCT coronary angiographies after sublingual Nitrate, no significant difference in the proximal diameter of all four

Breath-hold two-dimensional MR angiography of coronary arteries. Comparison with conventional coronary angiography in ten cases

International Nuclear Information System (INIS)

Li Liwei; Zhang Wanshi; Liu Chaozhong; Lu Xiaoyan; Xu Jiaxing

1997-01-01

Purpose: To assess the diagnostic value of two-dimensional coronary magnetic resonance (MR) angiography in patients evaluated for ischemic heart disease. Materials and methods: Ten patients who underwent selective cardiac catheterization with coronary MR angiography were evaluated with two-dimensional coronary MR angiography. Coronary MR angiography was performed with breath-hold fat-suppressed ECG-gated Turbo-FLASH with K-space segmentation using a 1.5 T imager. Results: The left main coronary artery, proximal left anterior descending artery, circumflex artery and right coronary artery were demonstrated in all cases. Continuous segments (mean) of left anterior descending, circumflex and right coronary arteries visualized on MRA were 6.72 +- 3.16 cm, 3.67 +- 4.81 cm and 7.93 +- 3.12 cm respectively. The overall sensitivity for detection of hemodynamically significant coronary artery lesion (≥50%) was 62.5% respectively. Conclusion: Breath-hold two-dimensional coronary MR angiography was useful in showing relatively long segments of the main coronary arteries and also has potential in depicting hemodynamically significant coronary artery lesions

Retinal layer location of increased retinal thickness in eyes with subclinical and clinical macular edema in diabetes type 2

DEFF Research Database (Denmark)

Bandello, Francesco; Tejerina, Amparo Navea; Vujosevic, Stela

2015-01-01

PURPOSE: To identify the retinal layer predominantly affected in eyes with subclinical and clinical macular edema in diabetes type 2. METHODS: A cohort of 194 type 2 diabetic eyes/patients with mild nonproliferative diabetic retinopathy (ETDRS levels 20/35) were examined with Cirrus spectral......-domain optical coherence tomography (OCT) at the baseline visit (ClinicalTrials.gov identifier: NCT01145599). Automated segmentation of the retinal layers of the eyes with subclinical and clinical macular edema was compared with a sample of 31 eyes from diabetic patients with normal OCT and an age......-matched control group of 58 healthy eyes. RESULTS: From the 194 eyes in the study, 62 had subclinical macular edema and 12 had clinical macular edema. The highest increases in retinal thickness (RT) were found in the inner nuclear layer (INL; 33.6% in subclinical macular edema and 81.8% in clinical macular edema...

Evaluation of Sialic Acid and Acute Phase Proteins (Haptoglobin and Serum Amyloid A in Clinical and Subclinical Bovine Mastitis

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S. Nazifi*, M. Haghkhah1, Z. Asadi, M. Ansari-Lari2, M. R. Tabandeh3, Z. Esmailnezhad and M. Aghamiri

2011-01-01

Full Text Available The present study was conducted to evaluate the concentrations of sialic acids (total, lipid bound and protein bound and their correlation with acute phase proteins (haptoglobin and serum amyloid A in clinical and subclinical mastitis of cattle. Thirty subclinical mastitic cows with positive California mastitis test (CMT test and no clinical signs of mastitis, 10 clinical mastitic cows and 10 healthy cows with negative CMT test and normal somatic cell count were selected. Milk and blood samples were collected after confirmation of clinical and subclinical mastitis by somatic cell count and bacterial identification. Serum haptoglobin (Hp, serum amyloid A (SAA, total sialic acid (TSA, lipid bound sialic acid (LBSA and protein bound sialic acid (PBSA were measured by validated standard methods. Haptoglobin and SAA increased significantly in both types of mastitis compared with control group (P<0.001. However, the ratio of HP/SAA was significantly different from the control group only in clinical mastitis. The results showed that TSA and LBSA were significantly different in control group compared with clinical and subclinical mastitis (P<0.001. Protein bound sialic acid did not change in subclinical mastitis in comparison with control group (P=0.86. There was positive correlation between LBSA and PBSA in clinical mastitis (r=0.72, P=0.02 whereas significant negative correlation was observed between LBSA and PBSA in subclinical mastitis (r=-0.62, P<0.001. Results also showed no correlation between Hp and SAA with each other or with any other parameters in study groups.

Current status of hybrid coronary revascularization.

Science.gov (United States)

Jaik, Nikhil P; Umakanthan, Ramanan; Leacche, Marzia; Solenkova, Natalia; Balaguer, Jorge M; Hoff, Steven J; Ball, Stephen K; Zhao, David X; Byrne, John G

2011-10-01

Hybrid coronary revascularization combines coronary artery bypass surgery with percutaneous coronary intervention techniques to treat coronary artery disease. The potential benefits of such a technique are to offer the patients the best available treatments for coronary artery disease while minimizing the risks of the surgery. Hybrid coronary revascularization has resulted in the establishment of new 'hybrid operating suites', which incorporate and integrate the capabilities of a cardiac surgery operating room with that of an interventional cardiology laboratory. Hybrid coronary revascularization has greatly augmented teamwork and cooperation between both fields and has demonstrated encouraging as well as good initial outcomes.

Comparative antibiogram of coagulase-negative Staphylococci (CNS) associated with subclinical and clinical mastitis in dairy cows.

Science.gov (United States)

Bansal, B K; Gupta, D K; Shafi, T A; Sharma, S

2015-03-01

The present study was planned to determine the in vitro antibiotic susceptibility of coagulase-negative Staphylococci (CNS) strains isolated from clinical and subclinical cases of mastitis in dairy cows. Antibiotic sensitivity profile will be helpful to recommend early therapy at the field level prior to availability of CST results. The milk samples from cases of clinical mastitis received in Mastitis Laboratory, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana and those of subclinical mastitis collected during routine screening of state dairy farms, were subjected to microbial culture. Identification of CNS organisms was done by standard biochemical tests. Antibiotic sensitivity testing, based on 30 antibiotics belonging to 12 groups, was done on 58 randomly selected CNS isolates (clinical isolates: 41, subclinical isolates: 17). Isolates were highly susceptible to chloramphenicol (98.3%), gentamicin (93.1%), streptomycin (91.4%), linezolid (91.4%), ceftixozime (87.9%), cloxacillin (86.2%), clotrimazole (86.2%), bacitracin (86.2%), enrofloxacin (84.5%) and ceftrioxone + tazobactum (70.7%), while resistance was observed against amoxicillin (77.6%), penicillin (75.9%), ampicillin (74.1%) and cefoperazone (51.7%). Overall, isolates from clinical cases of mastitis had a higher resistance than subclinical isolates. CNS isolates were susceptible to chloramphenicol, gentamicin and streptomycin, while higher resistance was recorded against routinely used penicillin group.

Thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus: a case report

Directory of Open Access Journals (Sweden)

Kunii Yasuto

2011-09-01

Full Text Available Abstract Introduction Non-convulsive status epilepticus is a form of epileptic seizure that occurs without convulsions. Recent reviews suggest that the diagnosis of non-convulsive status epilepticus remains difficult. Here, we report the case of a patient with thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus. Case presentation Our patient was a 68-year-old Japanese woman. The results of endocrine testing after her first episode of non-convulsive status epilepticus suggested latent subclinical hypothyroidism: she had elevated thyroid-stimulating hormone with normal levels of free tri-iodothyronine and free thyroxine. On examination, a diagnosis of thyroid disorder was not supported by other test results and our patient remained untreated. A follow-up examination revealed that her thyroid-stimulating hormone levels had spontaneously normalized. When she consulted another doctor for confusion, the transient increase in thyroid-stimulating hormone levels following non-convulsive status epilepticus was mistaken for subclinical hypothyroidism, and unfortunately treated with levothyroxine. Our patient then experienced levothyroxine-induced non-convulsive status epilepticus. Conclusions In this report, we suggested possible mechanisms for latent hypothyroid-like hormone abnormality following epileptic seizures and the possibility of provoking epileptic seizures by administering levothyroxine for misdiagnosed subclinical hypothyroidism.

Effects of elevated parameters of subclinical ketosis on the immune system of dairy cows: in vivo and in vitro results.

Science.gov (United States)

Schulz, Kirsten; Frahm, Jana; Kersten, Susanne; Meyer, Ulrich; Reiche, Dania; Sauerwein, Helga; Dänicke, Sven

2015-01-01

Using an established model in which subclinical ketosis is induced, the response of differential blood counts and levels of various haematological variables, including the inflammatory marker haptoglobin (Hp), were tested over the last six weeks of parturition until the 56th day post-partum in cows with lower or higher body condition scores (LBC and HBC, respectively; n = 9/group). Animals in the HBC group evidenced subclinical ketosis whereas LBC animals were metabolically healthy. For in vitro examination with ß-hydroxybutyrate (BHB) as a further stimulus, peripheral blood mononuclear cell (PBMC) counts of cows with and without subclinical ketosis (n = 5/group) were observed. Counts of leucocytes, granulocytes and lymphocytes (LY) peaked at day 1 post-partum in HBC cows, with a more marked increase in heifers. In subclinical ketosis LY count increased again, with significantly higher values in the HBC group. The red blood cell (RBC) profile was affected by parity (counts were higher in heifers). Hp showed a positive linear correlation with BHB and non-esterified fatty acids (NEFA; R(2) = 0.41). PBMC from cows that were not pre-stressed with subclinical ketosis were more sensitive to increasing levels of BHB in vitro, as evidenced by both their higher proliferative capability and increased release of nitric oxide (NO). In summary, cows with subclinical ketosis showed a heightened immune response compared with metabolically healthy individuals, based on increased LY counts, increasing stimulative properties of PBMC and a relationship between Hp and typically increased values of BHB and NEFA. Concentrations of BHB in vivo during subclinical ketosis did not alter the proliferative capability of bovine PBMC in vitro, which was first significantly decreased at a dosage of 5 mM BHB.

Milrinone infusion: A therapeutic option in coronary vasospasm after primary percutaneous transluminal coronary angioplasty

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Singh Amarpal

2009-01-01

Full Text Available A 42-year-old male presented to the emergency department with acute chest pain. The electrocardiogram revealed inferior wall myocardial infarction. Emergency coronary angiography revealed total occlusion of the distal right coronary artery with thrombus. Patient was taken up for primary percutaneous coronary angioplasty with stenting of distal right coronary artery. Six hours following the procedure, the patient developed re-elevation of ST-segment in inferior leads of electrocardiogram and subsequent haemodynamic instability. Repeat coronary angiography revealed patent stent and coronary artery spasm in proximal part, which was relieved by intracoronary injection of nitroglycerine. After an hour, the patient re-developed symptoms of chest pain along with bradycardia, hypotension and ST segment elevation. Intravenous infusion of nitroglycerine did not improve the condition but produced persistent hypotension. Infusion of milrinone was then started. Over time, normalisation of electrocardiogram occurred. The patient was discharged in stable condition. This case suggests that milrinone may be effective in alleviating coronary artery spasm when the use of other agents fails

A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

Science.gov (United States)

Yang, YoungSoon; Jin, Dong Gyu; Jang, Il Mi; Jang, YoungHee; Na, Hae Ri; Kim, SanYun

2010-01-01

Background Under certain conditions, exertional headaches may reflect coronary ischemia. Case Report A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. Conclusions A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test. PMID:20607049

Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.

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Toshiki Kuno

Full Text Available OBJECTIVE: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS patients undergoing percutaneous coronary intervention (PCI. BACKGROUND: Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease. METHODS: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group and those with left-dominant anatomy (LD group. RESULTS: The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003. In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001. Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030. CONCLUSION: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

[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.

Virulence factors genes of Staphylococcus spp. isolated from caprine subclinical mastitis.

Science.gov (United States)

Salaberry, Sandra Renata Sampaio; Saidenberg, André Becker Simões; Zuniga, Eveline; Melville, Priscilla Anne; Santos, Franklin Gerônimo Bispo; Guimarães, Ednaldo Carvalho; Gregori, Fábio; Benites, Nilson Roberti

2015-08-01

The aim of this study was to investigate genes involved in adhesion expression, biofilm formation, and enterotoxin production in isolates of Staphylococcus spp. from goats with subclinical mastitis and associate these results with the staphylococcal species. One hundred and twenty-four isolates were identified and polymerase chain reaction (PCR) was performed to detect the following genes: cna, ebpS, eno, fib, fnbA, fnbB, bap, sea, seb, sec, sed and see. The most commonly Staphylococcus species included S. epidermidis, S. lugdunensis, S. chromogenes, S. capitis ss capitis and S. intermedius. With the exception of fnbB, the genes were detected in different frequencies of occurrence in 86.3% of the Staphylococcus spp. isolates. Eno (73.2%) and bap (94.8%) were more frequently detected in coagulase-negative staphylococci (CNS); ebpS (76%), fib (90.9%) and fnbA (87%) were the most frequent genes in coagulase-positive staphylococci (CPS). Regarding enterotoxins, genes sed (28.2%) and see (24.2%) had a higher frequency of occurrence; sec gene was more frequently detected in CPS (58.8%). There was no association between the presence of the genes and the Staphylococcus species. Different virulence factors genes can be detected in caprine subclinical mastitis caused by CNS and CPS. The knowledge of the occurrence of these virulence factors is important for the development of effective control and prevention measures of subclinical mastitis caused by CNS and CPS in goats. Copyright © 2015 Elsevier Ltd. All rights reserved.

Detection of coronary calcium with electron beam tomography in coronary artery disease

International Nuclear Information System (INIS)

Haberl, R.; Knez, A.; Becker, A.; Becker, C.; Bruening, R.; Reiser, M.; Maass, A.; Steinbeck, G.

1998-01-01

Purpose: Coronary calcium is a powerful indicator of arteriosclerosis and can be detected very precisely with electron beam tomography. The method can be applied in patients with known coronary artery disease or in asymptomatic patients at risk of arteriosclerotic disease. Results: At the University of Munich we performed an EBT scan of the heart in 1100 patients within the last year. In 567 patients coronary angiography was performed also (±3 days). Confirming previous reports in the literature, we found a correlation of the calcium score with the age and gender of the patients. Severe coronary artery disease (stenoses ≥ 75%) was associated with significantly more calcium than less severe CAD. The calcium score did not discriminate between one-, two- and three-vessel disease. The site of calcification does not correlate with the localization of stenoses. Thirty-three percent of the patients with significant coronary artery disease showed a normal age-adjusted calcium score; a total of 8.1% of patients with severe stenoses did not reveal any coronary calcification (score =0). With asymptomatic patients there are only a few studies available. Soft plaques cannot be detected with EBT, but in most patients soft plaques occur together with hard plaques. Our results show that spiral CT of the newest generation may also be used for calcium screening. There was an excellent correlation of the calcium scores of EBT and spiral CT at all levels of calcification. Discussion: Coronary calcium is a sensitive marker of coronary artery disease. In the clinical setting EBT is indicated in patients with known coronary artery disease (to evaluate prognosis), in patients who are unable to perform a stress test, and in patients with atypical chest pain. However, lack of calcification may be associated with severe stenoses in a minority of patients. The clinical value in asymptomatic patients needs to be defined: Randomized studies are necessary. We see a possible indication in

USE OF CALIFORNIA MASTITIS TEST IN DIAGNOSIS OF SUBCLINICAL MASTITIS IN COWS

Directory of Open Access Journals (Sweden)

Nazif Varatanović

2013-09-01

Full Text Available Udder health control has been conducted in three different cow breeds by comparing the California Mastitis Test results in order to justify its use in detecting subclinical mastitis. The test examined 75 cows, or 228 quarters in total. In 76% of the cows of different breeds, the results of California Mastitis Test were positive. The tests were positive in one or two quarters with the intensity level of one, two and three. The test showed much higher percentage of positive reaction in the rear quarters. According to the results of our research, the continuous application of this test enables the early detection of subclinical mastitis resulting in its prevention and also improvement in quantity and milk quality.Key words: mastitis, California Mastitis Test, cow

Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

Energy Technology Data Exchange (ETDEWEB)

Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

2015-12-15

Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

Role of endothelial function in coronary slow-flow phenomenon with angiographically normal coronaries

Directory of Open Access Journals (Sweden)

Srikanth Nathani

2016-01-01

Conclusion: Coronary slow flow phenomenon is a marker of atherosclerosis (as documented by carotid intima media thickness and our study has also shown that endothelial function is significantly impaired in patients with coronary slow flow (as documented by impaired endothelial dependent vasodilatation than that of patients with normal epicardial coronaries with normal flow.

Determining the proportion of coronary segments assessable on 16-slice CT coronary angiography: a brief report

International Nuclear Information System (INIS)

Soon, K. H.; Cox, N.; Eccleston, D.; Lim, Y.; Chaitowitz, I.; Bell, K. W.; Kelly, A-M.

2007-01-01

Computed tomography coronary angiography (CT-CA) is becoming a popular non-invasive coronary imaging method. We aimed to determine the proportion of coronary segments assessable on a 16-slice CT in comparison with conventional selective coronary angiography (SCA). We identified all patients who had both 16-slice CT-CA and recent SCA (less than 12 months) from March 2004 to July 2005. Two CT reporters blinded to SCA independently classified coronary segment assessability on CT-CA. A cardiologist blinded to CT findings classified assess-ability of coronary segments on SCA. Data were analysed using descriptive statistics and proportion of agreement. Ninety-five study pairs were included in the analysis. Of those, 1161 coronary segments were deemed assessable on SCA and 1103 segments (95%) were also assessable on CT-CA. Nonassessable segments on CT-CA were predominantly in the distal segments and branches of coronary arteries. Reasons for nonassessability were small calibre (48.3%), motion artefacts (20.7%) and poorly reconstructed segments (22.4%). The 16-slice CT was able to assess a high proportion of but not all coronary segments. Nonassessable segments were predominantly distal segments or branches of coronary arteries. Motion artefacts due to heart-rate changes, small calibre and poorly reconstructed images were main causes of nonassessability on 16-slice CT-CA

Subclinical hypothyroidism and mortality in a large Austrian cohort: a possible impact on treatment?

Science.gov (United States)

Kovar, Florian Maria; Fang, I-Fei; Perkmann, Thomas; Haslacher, Helmuth; Slavka, Georg; Födinger, Manuela; Endler, Georg; Wagner, Oswald F

2015-12-01

Clinical implications of subclinical hypothyroidism (SCH) are still matter of intense debate, resulting in the controversial discussion whether subclinical hypothyroidism should be treated. We performed a cohort study to evaluate the impact of subclinical hypothyroidism on vascular and overall mortality. Between 02/1993 and 03/2004, a total of 103,135 persons attending the General Hospital Vienna with baseline serum thyrotropin (TSH, thyroid-stimulating hormone) and free thyroxin (fT4) measurements could be enrolled in a retrospective cohort study. Subclinical hypothyroidism was defined by elevated TSH ranging from 4.5 to 20.0 mIU/L and normal fT4 concentration (0.7-1.7 ng/dL). Overall and vascular mortality as primary endpoints were assessed via record linkage with the Austrian Death Registry. A total of 80,490 subjects fulfilled inclusion criteria of whom 3934 participants (3.7%) were classified as SCH (868 males and 3066 females, median age 48 years). The mean follow-up among the 80,490 subjects was 4.1 years yielding an observation period of 373,301 person-years at risk. In a multivariate Cox regression model adjusted for age and gender TSH levels showed a dose-dependent association with all-cause mortality. The association between SCH and overall or vascular mortality was stronger in men below 60 years compared to older males or females. Our data support the hypothesis that SCH might represent an independent risk factor for overall and vascular mortality, especially in men below 60 years. Whether this group would benefit from replacement therapy should be evaluated in interventional studies.

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.

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.)

Coffee consumption and coronary calcification: The Rotterdam coronary calcification study

NARCIS (Netherlands)

G.J. van Woudenbergh (Geertruida); R. Vliegenthart (Rozemarijn); F.J.A. van Rooij (Frank); A. Hofman (Albert); M. Oudkerk (Matthijs); J.C.M. Witteman (Jacqueline); J.M. Geleijnse (Marianne)

2008-01-01

textabstractBACKGROUND - The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. METHODS AND RESULTS - The study involved 1570 older men and women without coronary heart disease who

Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography

DEFF Research Database (Denmark)

Westra, Jelmer; Tu, Shengxian; Winther, Simon

2018-01-01

BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire...... patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv......, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50...

Relation of coronary vasoreactivity and coronary calcification in asymptomatic subjects with a family history of premature coronary artery disease

International Nuclear Information System (INIS)

Pirich, Christian; Leber, Alexander; Knez, Andreas; Bengel, Frank M.; Nekolla, Stephan G.; Schwaiger, Markus; Haberl, Ralph

2004-01-01

Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0-915). The CCS was 100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g -1 min -1 , 218±54 ml 100 g -1 min -1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age. (orig.)

Rest period duration of the coronary arteries: Implications for magnetic resonance coronary angiography

International Nuclear Information System (INIS)

Shechter, Guy; Resar, Jon R.; McVeigh, Elliot R.

2005-01-01

Magnetic resonance (MR) and computed tomography coronary imaging is susceptible to artifacts caused by motion of the heart. The presence of rest periods during the cardiac and respiratory cycles suggests that images free of motion artifacts could be acquired. In this paper, we studied the rest period (RP) duration of the coronary arteries during a cardiac contraction and a tidal respiratory cycle. We also studied whether three MR motion correction methods could be used to increase the respiratory RP duration. Free breathing x-ray coronary angiograms were acquired in ten patients. The three-dimensional (3D) structure of the coronary arteries was reconstructed from a biplane acquisition using stereo reconstruction methods. The 3D motion of the arterial model was then recovered using an automatic motion tracking algorithm. The motion field was then decomposed into separate cardiac and respiratory components using a cardiac respiratory parametric model. For the proximal-to-middle segments of the right coronary artery (RCA), a cardiac RP (<1 mm 3D displacement) of 76±34 ms was measured at end systole (ES), and 65±42 ms in mid-diastole (MD). The cardiac RP was 80±25 ms at ES and 112±42 ms at MD for the proximal 5 cm of the left coronary tree. At end expiration, the respiratory RP (in percent of the respiratory period) was 26±8% for the RCA and 27±17% for the left coronary tree. Left coronary respiratory RP (<0.5 mm 3D displacement) increased with translation (32% of the respiratory period), rigid body (51%), and affine (79%) motion correction. The RCA respiratory RP using translational (27%) and rigid body (33%) motion correction were not statistically different from each other. Measurements of the cardiac and respiratory rest periods will improve our understanding of the temporal and spatial resolution constraints for coronary imaging

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

Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

DEFF Research Database (Denmark)

Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita

2013-01-01

The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

Insulin resistance and glucose levels in subjects with subclinical hypothyroidism

International Nuclear Information System (INIS)

Kahn, S.H.; Fazal, N.; Yasir, M.; Asif, N.; Rafi, T.

2017-01-01

To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, from December 2015 to September 2016. Methodology: Subjects referred for executive screening of apparently healthy population (without any known history of diabetes, hypertension, heart disease or other chronic ailments), were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism. Results: Median (IQR) insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 (n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mIU/L) and group-2 (n=26, 13%, Thyroid Stimulating Hormone: 3.51 - 15 mIU/L) were 7.6 (6.70) vs. 11.4 (13.72, p=0.040) and 1.77 (1.79) vs. 2.8 (3.07, p=0.071). The median differences for fasting plasma glucose were 5.0 (1.0) in group-1 vs. 5.0 (1.47) for Group-2 [p=0.618], and glycated hemoglobin was 5.60 (1.1) vs. 5.60 (1.7, p=0.824). Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median (IQR) 86.67 (92.94)] than group-1 [111.6 (189.64, p= 0.040)]. Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism. (author)

The use of Na+ and K+ ion concentrations as potential diagnostic indicators of subclinical mastitis in dairy cows

Directory of Open Access Journals (Sweden)

Abdul Wahid Haron

2014-11-01

Full Text Available Aim: This study was conducted to evaluate the concentrations of sodium (Na+ and potassium (K+ ions in milk of lactating dairy cows with and without subclinical mastitis as putative indicators for detecting subclinical mastitis in dairy cows. Materials and Methods: Thirty seven lactating dairy cows were screened for the evidence of subclinical mastitis using California mastitis test (CMT. The lactating dairy cows were categorized as CMT-Positive (CMT-P; n=20 and CMT-Negative (CMT-N; n=17 based on whether they were positive or negative for CMT using a standard kit. The CMT-P lactating dairy cows were further sub divided into subclinical 1+ (S1+; n=6, subclinical 2+ (S2+; n=9, and subclinical 3+(S3+; n=5. Direct microscopy somatic cell count (SCC was used to determine the SCC using Wright’s stain. The samples were filtered and diluted at 1:100 dilutions before being measured for the concentrations of Na+ and K+ using atomic absorption spectrophotometer. Results: There was a significant increase (p<0.05 in SCCs and Na+ concentration in the milk of CMT-P dairy cows, with a mean Log10 SCC score of 5.35±0.06 cells/ml and mean Na+ concentration of 232±19.1 mg/dL. However, there was a significant reduction (p<0.05 in the concentration of K+ (123±7.6 mg/dL in the milk samples of the CMT-P cows. There were significant differences (p<0.05 in SCC, Na+ and K+ concentrations between milk samples from the CMT-N dairy cows and CMT-P subgroups; S1+, S2+, and S3+ respectively. Potassium (K+ concentration had a significant strong negative correlation with sodium (Na+ concentration (r=−0.688; p<0.01 and weak positive correlation with SCC (r=−0.436; p<0.01. The sensitivity of using Na+ and K+ concentrations as detection indices for sub-clinical mastitis is 40% and 90%, respectively, while the specificity of each was 100%. Conclusion: This study thus shows that evaluation of Na+ and K+ concentrations from milk samples of dairy cows with sub clinical mastitis

Prevalence and aetiology of subclinical mastitis in goats

Directory of Open Access Journals (Sweden)

Igor Štoković

2010-01-01

Full Text Available The study was conducted in 2006 on 20 French alpine goat farms in Croatia. Milk samples were taken from each udder half, for the mastitis test and the bacteriological test, 2120 samples in total. Subclinical mastitis was diagnosed in 211 out of 1060 goats, or in 20% of the studied population. Mastitis of one udder half was diagnosed in 84% of the affected population, while mastitis of both udder halves was diagnosed in 16% of the affected goats. A positive mastitis test reaction was identified in 605 samples (28%, and the pathogenic bacterium was isolated from 244 of these samples (36%. From 22 samples (1.5% which were negative to mastitis test, pathogenic bacteria, namely S. aureus (21 samples and Streptococcus D (1 sample, were isolated. Staphylococcus aureus was isolated from 72% mastitis test positive samples, coagulase-negative staphylococci in 16%, other bacteria were isolated from a smaller number of samples: Streptococcus D (6%, Bacillus spp. (2%, and E. coli (2%. The results of the study lead to the conclusion that the subclinical mastitis in goats has a prevalence of 20% on average which increases with higher lactation number. Staphylococcus aureus is the primary causative agent of the inflammations.

Coffee consumption and coronary calcification - The Rotterdam Coronary Calcification Study

NARCIS (Netherlands)

van Woudenbergh, Geertruida J.; Vliegenthart, Rozemarijn; van Rooij, Frank J. A.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jacqueline C. M.; Geleijnse, Johanna M.

Background-The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results-The study involved 1570 older men and women without coronary heart disease who participated in the

Genetic parameters of subclinical macromineral disorders and major clinical diseases in postparturient Holstein cows.

Science.gov (United States)

Tsiamadis, V; Banos, G; Panousis, N; Kritsepi-Konstantinou, M; Arsenos, G; Valergakis, G E

2016-11-01

The main objective of this study was to assess the genetic parameters of subclinical disorders associated with subclinical hypocalcemia, hypophosphatemia, subclinical hypomagnesemia, hypokalemia, and hyperphosphatemia, as well as major clinical diseases after calving in Holstein cows. The secondary objective was to estimate the associated genetic and phenotypic correlations among these subclinical and clinical conditions after calving in Holstein cows. The study was conducted in 9dairy herds located in Northern Greece. None of the herds used any kind of preventive measures for milk fever (MF). A total of 1,021 Holstein cows with pedigree information were examined from November 2010 until November 2012. The distribution across parities was 466 (parity 1), 242 (parity 2), 165 (parity 3), and 148 (parity 4 and above) cows. All cows were subjected to a detailed clinical examination and blood was sampled on d 1, 2, 4, and 8 after calving. Serum concentrations of Ca, P, Mg, and K were measured in all samples, whereas β-hydroxybutyrate (BHB) was measured only for d 8. The final data set included 4,064 clinical and 16,848 biochemical records (4,020 Ca, 4,019 P, 4,020Mg, 3,792K, and 997 BHB). Data of 1,988 observations of body condition score at d 1 and 8 were also available. All health traits were analyzed with a univariate random regression model. The genetic analysis for macromineral-related disorders included 986 cows with no obvious signs of MF (35 cows with MF were excluded). Analysis for other health traits included all 1,021 cows. A similar single record model was used for the analysis of BHB. Genetic correlations among traits were estimated with a series of bivariate analyses. Statistically significant daily heritabilities of subclinical hypocalcemia (0.13-0.25), hypophosphatemia (0.18-0.33), subclinical hypomagnesemia (0.11-0.38), and hyperphosphatemia (0.14-0.22) were low to moderate, whereas that of hypokalemia was low (0.08-0.10). The heritability of body

Model of the coronary circulation based on pressure dependence of coronary resistance and compliance

NARCIS (Netherlands)

Bruinsma, P.; Arts, T.; Dankelman, J.; Spaan, J. A.

1988-01-01

The effect of pressure-dependent changes in vascular volume, resistance and capacitance in the coronary micro-circulation, has been studied by a distributed mathematical model of the coronary micro-vasculature in the left ventricular wall. The model does not include regulation of coronary blood flow

Soluble CD30 correlates with clinical but not subclinical renal allograft rejection.

Science.gov (United States)

Hirt-Minkowski, Patricia; Roth, Michèle; Hönger, Gideon; Amico, Patrizia; Hopfer, Helmut; Schaub, Stefan

2013-01-01

Soluble CD30 (sCD30) has been proposed as a promising noninvasive biomarker for clinical renal allograft rejection, but its diagnostic characteristics regarding detection of subclinical rejection have not been assessed. We investigated sCD30 in 146 consecutive kidney allograft recipients under tacrolimus-mycophenolate-based immunosuppression having 250 surveillance biopsies at 3 and 6 months as well as 52 indication biopsies within the first year post-transplant. Allograft histology results were classified as (i) acute Banff score zero or interstitial infiltrates only, (ii) tubulitis t1, (iii) tubulitis t2-3 and (iv) isolated vascular compartment inflammation. sCD30 correlated well with the extent of clinical (P sCD30, histological groups were assigned to two categories: no relevant inflammation (i.e. acute Banff score zero and interstitial infiltrates only) versus all other pathologies (tubulitis t1-3 and isolated vascular compartment inflammation). For clinical allograft inflammation, AUC was 0.87 (sensitivity 89%, specificity 79%; P = 0.0006); however, for subclinical inflammation, AUC was only 0.59 (sensitivity 50%, specificity 69%; P = 0.47). In conclusion, sCD30 correlated with clinical, but not subclinical renal allograft rejection limiting its clinical utility as a noninvasive rejection screening biomarker in patients with stable allograft function receiving tacrolimus-mycophenolate-based immunosuppression. © 2012 The Authors Transplant International © 2012 European Society for Organ Transplantation.

Divergent cellular responses during asymptomatic subclinical and clinical states of disease in cows naturally infected with Mycobacterium avium subsp. paratuberculosis

Science.gov (United States)

Infection of the host with Mycobacterium avium subsp. paratuberculosis (MAP) results in a chronic and progressive enteritis that traverses both subclinical and clinical stages. The mechanism(s) for the shift from asymptomatic subclinical disease state to advanced clinical disease are not fully under...

Subclinical decelerations during developing hypotension in preterm fetal sheep after acute on chronic lipopolysaccharide exposure

Science.gov (United States)

Lear, Christopher A.; Davidson, Joanne O.; Galinsky, Robert; Yuill, Caroline A.; Wassink, Guido; Booth, Lindsea C.; Drury, Paul P.; Bennet, Laura; Gunn, Alistair J.

2015-01-01

Subclinical (shallow) heart rate decelerations occur during neonatal sepsis, but there is limited information on their relationship with hypotension or whether they occur before birth. We examined whether subclinical decelerations, a fall in fetal heart rate (FHR) that remained above 100 bpm, were associated with hypotension in preterm fetal sheep exposed to lipopolysaccharide (LPS). Chronically-instrumented fetal sheep at 0.7 gestation received continuous low-dose LPS infusions (n = 15, 100 ng/kg over 24 h, followed by 250 ng/kg/24 h for 96 h) or saline (n = 8). Boluses of 1 μg LPS or saline were given at 48 and 72 h. FHR variability (FHRV) was calculated, and sample asymmetry was used to assess the severity and frequency of decelerations. Low-dose LPS infusion did not affect FHR. After the first LPS bolus, 7 fetuses remained normotensive, while 8 developed hypotension (a fall in mean arterial blood pressure of ≥5 mmHg). Developing hypotension was associated with subclinical decelerations, with a corresponding increase in sample asymmetry and FHRV (p < 0.05). The second LPS bolus was associated with similar but attenuated changes in FHR and blood pressure (p < 0.05). In conclusion, subclinical decelerations are not consistently seen during prenatal exposure to LPS, but may be a useful marker of developing inflammation-related hypotension before birth. PMID:26537688

Effect of subclinical mastitis caused by ss-haemolytic streptococci on ...

African Journals Online (AJOL)

Mastitis is a major constraint to milk production in camels. We conducted a survey in Marsabit and Isiolo counties of Kenya to quantify losses in milk yield associated with subclinical mastitis caused by ß-haemolytic Streptococci in the one-humped camel (Camelus dromedarius). Four hundred and twenty (420) pair wise ...

Coffee Consumption and Coronary Calcification: The Rotterdam Coronary Calcification Study

NARCIS (Netherlands)

Woudenbergh, van G.J.; Vliegenthart, R.; Rooij, van F.J.A.; Hofman, A.; Oudkerk, M.; Witteman, J.C.M.; Geleijnse, J.M.

2008-01-01

Background¿ The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results¿ The study involved 1570 older men and women without coronary heart disease who participated in the

Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis.

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Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J; Ikram, M Arfan; Blum, Manuel R; Collet, Tinh-Hai; Bakker, Stephan J L; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N; Hofman, Albert; Portegies, Marileen L P; Medici, Marco; Iervasi, Giorgio; Stott, David J; Ford, Ian; Bremner, Alexandra; Wanner, Christoph; Ferrucci, Luigi; Newman, Anne B; Dullaart, Robin P; Sgarbi, José A; Ceresini, Graziano; Maciel, Rui M B; Westendorp, Rudi G; Jukema, J Wouter; Imaizumi, Misa; Franklyn, Jayne A; Bauer, Douglas C; Walsh, John P; Razvi, Salman; Khaw, Kay-Tee; Cappola, Anne R; Völzke, Henry; Franco, Oscar H; Gussekloo, Jacobijn; Rodondi, Nicolas; Peeters, Robin P

2015-06-01

The objective was to determine the risk of stroke associated with subclinical hypothyroidism. Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

Prevalence of clinical and subclinical mastitis and quality of milk on smallholder dairy farms in Tanzania

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R.H. Mdegela

2009-05-01

Full Text Available A cross sectional study was conducted during October and November 2006 on 69 smallholder dairy farms with lactating cows in Mvomero and Njombe districts Tanzania, to determine the prevalence of mastitis and to assess the milk quality on the study farms. Clinical mastitis was investigated using clinical changes of udder and milk at animal level. Cow-side California Mastitis Test (CMT and microbiological cultures were used to assess subclinical mastitis at quarter level. Milk quality was determined on bulk milk samples at herd level using alcohol and acidity tests, butter fat content, total solids, ash content as well as Delvotest® for antimicrobial residues. Overall prevalence of clinical mastitis at herd level in both districts was 21.7 % (n = 69. Based on CMT, prevalence of subclinical mastitis at animal level was 51.6 % (n = 91. Prevalence of bacterial isolates at animal level was 35.2 % (n = 91 while for fungal it was 16.7 % (n = 90. Based on CMT results, prevalence of subclinical mastitis at quarter level was 30 % (n = 353, while for bacteria and fungi it was 16 % and 6 % respectively. Contamination of milk with antimicrobial residues was 4.5 % (n =67. The milk quality parameters for most of the milk samples were within acceptable levels. Findings in this study have demonstrated high prevalence of subclinical mastitis that may contribute to low productivity of dairy cattle in both districts. About 20 % of CMT subclinical cases had no involvement of microbial pathogens that suggested the need for minimal interventions with antimicrobial agents. These findings call for use of udder disinfectants and improved milking hygiene as intervention strategies to control mastitis on the smallholder dairy farms in Tanzania.

The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

DEFF Research Database (Denmark)

Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

2011-01-01

To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

Optimization of coronary attenuation in coronary computed tomography angiography using diluted contrast material.

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Kawaguchi, Naoto; Kurata, Akira; Kido, Teruhito; Nishiyama, Yoshiko; Kido, Tomoyuki; Miyagawa, Masao; Ogimoto, Akiyoshi; Mochizuki, Teruhito

2014-01-01

The purpose of this study was to evaluate a personalized protocol with diluted contrast material (CM) for coronary computed tomography angiography (CTA). One hundred patients with suspected coronary artery disease underwent retrospective electrocardiogram-gated coronary CTA on a 256-slice multidetector-row CT scanner. In the diluted CM protocol (n=50), the optimal scan timing and CM dilution rate were determined by the timing bolus scan, with 20% CM dilution (5ml/s during 10s) being considered suitable to achieve the target arterial attenuation of 350 Hounsfield units (HU). In the body weight (BW)-adjusted protocol (n=50, 222mg iodine/kg), only the optimal scan timing was determined by the timing bolus scan. The injection rate and volume in the timing bolus scan and real scan were identical between the 2 protocols. We compared the means and variations in coronary attenuation between the 2 protocols. Coronary attenuation (mean±SD) in the diluted CM and BW-adjusted protocols was 346.1±23.9 HU and 298.8±45.2 HU, respectively. The diluted CM protocol provided significantly higher coronary attenuation and lower variance than did the BW-adjusted protocol (P<0.05, in each). The diluted CM protocol facilitates more uniform attenuation on coronary CTA in comparison with the BW-adjusted protocol.  

Postnatal Mother-to-Infant Attachment in Subclinically Depressed Mothers: Dyads at Risk?

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Behrendt, Hannah F; Konrad, Kerstin; Goecke, Tamme W; Fakhrabadi, Roya; Herpertz-Dahlmann, Beate; Firk, Christine

Dyadic interactions between children and depressed mothers have been characterized as less synchronous and with lower maternal sensitivity, fostering an inharmonious, insecure attachment relationship between mother and child. Thus, these children may experience enhanced early life stress and are at higher risk of disturbed socioemotional development. Recently, this association has also been found in women with mild depressive symptoms. However, potential confounding effects of mother's history of own rearing experiences or infant temperament on the link between depressive symptoms and postnatal mother-to-infant attachment have not yet been investigated. Differences in mother-to-infant attachment (e.g. quality of attachment, absence of hostility, and pleasure in interaction) between mothers with and without symptoms of depression 6-8 months postpartum were analyzed in a low-risk community sample (n = 38, 19 per group). Depressive symptomatology was measured with the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Depressed mothers indicated mild-to-moderate depressive symptomatology (mean BDI-II 11.26 ± 3.86) but did not fulfill criteria for a major depressive episode and, thus, were referred to as 'subclinically' depressed. Potential confounders, namely maternal history of own rearing experiences and infant temperament, were explored by multivariate AN(C)OVA. Primiparous mothers with subclinical depression differed significantly from healthy control mothers, i.e. showed poorer mother-to-infant attachment and higher infant-related hostility 6-8 months postpartum. As expected, infant temperament and mother's history of own rearing experiences were both associated with mother-to-infant attachment but did not explain the negative effects of subclinical depression on the mother-infant relationship. Given the high prevalence of maternal depression, the current findings give reason for increased concern for the developing mother

Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat.

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Karolina Barszcz

Full Text Available The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2-18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch, type II (12 animals, 26%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch, type III (11 animals, 23%-triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%-double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch. The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat.

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.

Coronary artery calcification in Kawasaki disease

International Nuclear Information System (INIS)

Ino, T.; Shimazaki, S.; Akimoto, K.; Park, I.; Nishimoto, K.; Yabuta, K.; Tanaka, A.

1990-01-01

To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest X-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest X-ray in 2 patients with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination. (orig.)

Decreased naive and increased memory CD4(+ T cells are associated with subclinical atherosclerosis: the multi-ethnic study of atherosclerosis.

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Nels C Olson

Full Text Available Adaptive immunity has been implicated in atherosclerosis in animal models and small clinical studies. Whether chronic immune activation is associated with atherosclerosis in otherwise healthy individuals remains underexplored. We hypothesized that activation of adaptive immune responses, as reflected by higher proportions of circulating CD4(+ memory cells and lower proportions of naive cells, would be associated with subclinical atherosclerosis.We examined cross-sectional relationships of circulating CD4(+ naive and memory T cells with biomarkers of inflammation, serologies, and subclinical atherosclerosis in 912 participants of the Multi-Ethnic Study of Atherosclerosis (MESA. Circulating CD4(+ naive cells were higher in women than men and decreased with age (all p-values <0.0001. European-Americans had higher levels of naive cells and lower levels of memory cells compared with African-Americans and Hispanic-Americans (all p-values ≤0.0005. Lower naive/higher memory cells were associated with interleukin-6 levels. In multivariate models, cytomegalovirus (CMV and H. Pylori titers were strongly associated with higher memory and lower naive cells (all p-values <0.05. Higher memory cells were associated with coronary artery calcification (CAC level in the overall population [β-Coefficient (95% confidence interval (CI  = 0.20 (0.03, 0.37]. Memory and naive (inversely cells were associated with common carotid artery intimal media thickness (CC IMT in European-Americans [memory: β =  0.02 (0.006, 0.04; naive: β = -0.02 (-0.004, -0.03].These results demonstrate that the degree of chronic adaptive immune activation is associated with both CAC and CC IMT in otherwise healthy individuals, consistent with the known role of CD4(+ T cells, and with innate immunity (inflammation, in atherosclerosis. These data are also consistent with the hypothesis that immunosenescence accelerates chronic diseases by putting a greater burden on the innate

Comparative antibiogram of coagulase-negative Staphylococci (CNS associated with subclinical and clinical mastitis in dairy cows

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B. K. Bansal

2015-03-01

Full Text Available Aim: The present study was planned to determine the in vitro antibiotic susceptibility of coagulase-negative Staphylococci (CNS strains isolated from clinical and subclinical cases of mastitis in dairy cows. Antibiotic sensitivity profile will be helpful to recommend early therapy at the field level prior to availability of CST results. Materials and Methods: The milk samples from cases of clinical mastitis received in Mastitis Laboratory, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana and those of subclinical mastitis collected during routine screening of state dairy farms, were subjected to microbial culture. Identification of CNS organisms was done by standard biochemical tests. Antibiotic sensitivity testing, based on 30 antibiotics belonging to 12 groups, was done on 58 randomly selected CNS isolates (clinical isolates: 41, subclinical isolates: 17. Results: Isolates were highly susceptible to chloramphenicol (98.3%, gentamicin (93.1%, streptomycin (91.4%, linezolid (91.4%, ceftixozime (87.9%, cloxacillin (86.2%, clotrimazole (86.2%, bacitracin (86.2%, enrofloxacin (84.5% and ceftrioxone + tazobactum (70.7%, while resistance was observed against amoxicillin (77.6%, penicillin (75.9%, ampicillin (74.1% and cefoperazone (51.7%. Overall, isolates from clinical cases of mastitis had a higher resistance than subclinical isolates. Conclusion: CNS isolates were susceptible to chloramphenicol, gentamicin and streptomycin, while higher resistance was recorded against routinely used penicillin group.

[Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism].

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Curotto Grasiosi, Jorge; Peressotti, Bruno; Machado, Rogelio A; Filipini, Eduardo C; Angel, Adriana; Delgado, Jorge; Cortez Quiroga, Gustavo A; Rus Mansilla, Carmen; Martínez Quesada, María del Mar; Degregorio, Alejandro; Cordero, Diego J; Dak, Marcelo; Izurieta, Carlos; Esper, Ricardo J

2013-10-01

To assess whether levothyroxine treatment improves functional capacity in patients with chronic heart failure (New York Heart Association class i-iii) and subclinical hypothyroidism. One hundred and sixty-three outpatients with stable chronic heart failure followed up for at least 6 months were enrolled. A physical examination was performed, and laboratory tests including thyroid hormone levels, Doppler echocardiogram, radionuclide ventriculography, and Holter monitoring were requested. Functional capacity was assessed by of the 6-min walk test. Patients with subclinical hypothyroidism were detected and, after undergoing the s6-min walk test, were given replacement therapy. When they reached normal thyrotropin (TSH) levels, the 6-min walk test was performed again. The distance walked in both tests was recorded, and the difference in meters covered by each patient was analyzed. Prevalence of subclinical hypothyroidism in patients with heart failure was 13%. These patients walked 292±63m while they were hypothyroid and 350±76m when TSH levels returned to normal, a difference of 58±11m (P<.011). Patients with normal baseline TSH levels showed no significant difference between the 2 6-min walk tests. Patients with chronic heart failure and subclinical hypothyroidism significantly improved their physical performance when normal TSH levels were reached. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

[Comparison of Discriminant Analysis and Decision Trees for the Detection of Subclinical Keratoconus].

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Kleinhans, Sonja; Herrmann, Eva; Kohnen, Thomas; Bühren, Jens

2017-08-15

Background Iatrogenic keratectasia is one of the most dreaded complications of refractive surgery. In most cases, keratectasia develops after refractive surgery of eyes suffering from subclinical stages of keratoconus with few or no signs. Unfortunately, there has been no reliable procedure for the early detection of keratoconus. In this study, we used binary decision trees (recursive partitioning) to assess their suitability for discrimination between normal eyes and eyes with subclinical keratoconus. Patients and Methods The method of decision tree analysis was compared with discriminant analysis which has shown good results in previous studies. Input data were 32 eyes of 32 patients with newly diagnosed keratoconus in the contralateral eye and preoperative data of 10 eyes of 5 patients with keratectasia after laser in-situ keratomileusis (LASIK). The control group was made up of 245 normal eyes after LASIK and 12-month follow-up without any signs of iatrogenic keratectasia. Results Decision trees gave better accuracy and specificity than did discriminant analysis. The sensitivity of decision trees was lower than the sensitivity of discriminant analysis. Conclusion On the basis of the patient population of this study, decision trees did not prove to be superior to linear discriminant analysis for the detection of subclinical keratoconus. Georg Thieme Verlag KG Stuttgart · New York.

Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

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Ulimoen, G. R.; Gjoennaess, E.; Atar, D.; Dahl, T.; Stranden, E.; Sandbaek, G. (Dept. of Radiology, Dept. of Vascular Diagnosis and Research, and Division of Cardiology, Aker Univ. Hospital, Oslo (Norway))

2008-12-15

Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.

Noninvasive Coronary Angiography with 64-Channel Multidetector Computed Tomography in Patients with Acute Coronary Syndrome

International Nuclear Information System (INIS)

Ulimoen, G. R.; Gjoennaess, E.; Atar, D.; Dahl, T.; Stranden, E.; Sandbaek, G.

2008-01-01

Background: Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. Purpose: To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). Material and Methods: MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. Results: 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Conclusion: Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome

Aneurysmal coronary artery disease: An overview

Science.gov (United States)

ElGuindy, Mohamed S.

Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease. PMID:29564347

Detection of Subclinical Ketosis in Dairy Cows

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Zhigang Zhang, Guowen Liu1, Hongbin Wang, Xiaobing Li1 and Zhe Wang1*

2012-05-01

Full Text Available Ketosis is a common metabolic disorder frequently observed in dairy cows during the early lactation period. It is characterized by increased levels of ketone bodies in the blood, urine, and milk. Subclinical ketosis (SCK in dairy cattle is an excess level of circulating ketone bodies in the absence of clinical signs of ketosis. Usually, detection of SCK is carried out by testing the ketone concentrations in blood, urine, and milk. Here, This review overview the detection methods for SCK in dairy cows, including cowside and laboratory tests.

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...

Association of metabolic risks with subclinical hypothyroidism: A cross-sectional analysis.

Science.gov (United States)

Khan, Sikandar Hayat; Manzoor, Syed Mohsin; Niazi, Najumusaquib Khan; Asif, Naveed; Ijaz, Aamir; Fazal, Nadeem

2018-01-01

To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism. This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:≥ 10.0 mIU/L, n=9). LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant. LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.

Glucose tolerance and lipid profile in longterm exogenous subclinical hyperthyroidism and the effects of restoration of euthyroidism, a randomised controlled trial

NARCIS (Netherlands)

Heemstra, K. A.; Smit, J. W. A.; Eustatia-Rutten, C. F. A.; Heijboer, A. C.; Frölich, M.; Romijn, J. A.; Corssmit, E. P. M.

2006-01-01

The impact of prolonged subclinical hyperthyroidism on glucose and lipid metabolism is unclear. Therefore, we evaluated glucose and lipid metabolism in patients with differentiated thyroid carcinoma (DTC) on TSH suppressive thyroxine therapy as a model for subclinical hyperthyroidism and

Frequency and importance of radiologically visible coronary scleroses

International Nuclear Information System (INIS)

Hoyer, B.

1981-01-01

The importance of radiologically visible coronary sceleroses for an early diagnosing of coronary heart disease was investigated. In 3 mixed collectives of patients with and without coronary heart diseases who had had a coronary angiography were examined retrospectively for coronary sclerosis (group I: standard films, group II: old X-ray findings, group III: fluoroscopy before beginning coronary angiography). In the retrospective evaluation, the sensitivity to the recognition of coronary heart disease was low. With prospective examination by means of fluoroscopy, coronary calcification could be proven in 37.66% of the patients with coronary diseases (sensitivity); the specificity (no coronary calcification in persons without coronary disease) was 99%. The duration and extent of a calcification do not show a definite influence on the severity of the disease. Several coronary scleroses in one or several vessels mostly indicate a vascular disease. Coronary scleroses are not necessarily located in the same point as coronary stenoses: in 85.5% of the patients with coronary sclerosis of the left truncus, haemodynamically important stenoses were found only in following vascular regions. Considering the high specificity of coronary scleroses in the fluoroscopic picture and the high sensitivity under favourable conditions, this method seems to be suitable as a screening method for early recognition of coronary heart diseases in the asymptomatic stage. A proven coronary sclerosis should in any case be the cause for continuing the search for a coronary heart disease. The radiation exposure during fluoroscopy of coronary sclerosis is low if the adjustment is correct, it takes little time, the patient is not put to discomfort. (orig./MG) [de

Effects of 1 or 2 treatments with prostaglandin F₂α on subclinical endometritis and fertility in lactating dairy cows inseminated by timed artificial insemination.

Science.gov (United States)

Lima, F S; Bisinotto, R S; Ribeiro, E S; Greco, L F; Ayres, H; Favoreto, M G; Carvalho, M R; Galvão, K N; Santos, J E P

2013-10-01

The objectives of the current study were to investigate the efficacy of PGF₂α as a therapy to reduce the prevalence of subclinical endometritis and improve pregnancy per artificial insemination (P/AI) in cows subjected to a timed artificial insemination (AI) program. A total of 1,342 lactating Holstein dairy cows were allocated randomly at 25 ± 3 d in milk (DIM) to remain as untreated controls (control, n=454) or to receive a single PGF₂α treatment at 39 ± 3 DIM (1PGF, n=474) or 2 treatments with PGF(α at 25 ± 3 and 39 ± 3 DIM (2PGF, n=414). All cows were enrolled in the double Ovsynch program at 48 ± 3 DIM and were inseminated at 75 ± 3 DIM. A subset of 357 cows had uterine samples collected for cytological examination at 25 ± 3, 32 ± 3, and 46 ± 3 DIM to determine the percentage of polymorphonuclear leukocytes (PMNL). Subclinical endometritis was defined by the presence of ≥ 5% PMNL. Vaginal discharge score was evaluated at 25 ± 3 DIM and used to define the prevalence of purulent vaginal discharge. Body condition score was assessed at 25 ± 3 DIM. Pregnancy was diagnosed 32 d after AI and reconfirmed 28 d later. At 32 ± 3 DIM, the prevalence of subclinical endometritis was reduced by treatment with PGF₂α at 25 ± 3 DIM in 2PGF (control=23.5% vs. 1PGF=28.3% vs. 2PGF=16.7%); however, this benefit disappeared at 46 ± 3 DIM, and 14% of the cows remained with subclinical endometritis. One or 2 treatments with PGF₂α did not influence P/AI on d 32 or 60 after timed AI, which averaged 39.9 and 35.2%. Similarly, treatment with PGF₂α had no effect on pregnancy loss between 32 and 60 d of gestation (11.9%). Cows diagnosed with both purulent vaginal discharge and subclinical endometritis had the lowest P/AI and the highest pregnancy loss compared with those diagnosed with only 1 of the 2 diseases or compared with cows having no diagnosis of uterine diseases. Interestingly, subclinical endometritis depressed P/AI and increased pregnancy loss only

THE PLURAL LESION CORONARY AND CYTOKINES DISBALANCE IN PATIENTS WITH CORONARY ATHEROSCLEROSIS

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Martynov AV

2012-12-01

Full Text Available The aim of the study was to examine the levels of the main pro-inflammatory and anti-inflammatory cytokines in patients with ischemic heart disease, and the study of the possible impact of persistent herpes virus infection plural lesion coronary arteries. A total of 57 patients (mean age 49,3 ± 3,7 years IHD s hemodynamically significant stenoses of the coronary vessels. Conducted virological examination, including the definition of hypertension HSV1, HSV2, HHV6, SMV, VZV and VEB immunofluorescent and cytokines ІL-1β, ІL-6 ІL-8, TNF by ELISA in serum. Found increased levels of proinflammatory cytokines ІL-1β, ІL-6 and FNPα of IHD patients who had hemodynamically significant stenoses of coronary vessels. ІL-6 level in patients with 2 or more significant coronary artery lesions exceeded the rate of patients with a damaged coronary artery in 1.67 TNFα, ІL-8 - 1.37 ІL-1β and 1.28 times respectively. In patients with plural coronary vascular damage was the most common combination of CMV, VEB and HHV6. Since CMV was detected in more than 60% of patients with injuries of two spacecraft and nearly 76% from three spacecraft, VEB was detected in 72% and 88%, respectively.

A rare anomaly: Double right coronary artery

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Dursun Çayan Akkoyun

2013-01-01

Full Text Available Coronary artery anomalies are rare anomalies. Theseare usually asymptomatic and are discovered incidentally.Double right coronary artery (RCA is a rare coronaryartery anomaly. Although there is controversy aboutidentification and classification of double RCA, it is oftena benign condition, but it can be complicated by atherosclerosisand can lead to serious conditions such asmyocardial infarction (MI and may be accompanied byother anomalies. In our case, double RCA were detectedin coronary angiography for acute anterior MI, and in thenext session successful percutaneous coronary interventionwas performed.Key words: Coronary anomaly, coronary angiography,coronary stenosis

Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE)

DEFF Research Database (Denmark)

Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell

2016-01-01

Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main...... coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable......, and 5% versus 2% (2 . 25, 0 . 93-5 . 48, p= 0 . 073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease....

Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism

DEFF Research Database (Denmark)

Faber, J; Petersen, L; Wiinberg, N

2002-01-01

by LT(4) (p treatment in SH results in changes in hemodynamic parameters of potentially beneficial character. SH and overt hypothyroidism should......In hypothyroidism, lack of thyroid hormones results in reduced cardiac function (cardiac output [CO]), and an increase of systemic vascular resistance (SVR). We speculated whether hemodynamic regulation in subjects with subclinical hypothyroidism (SH) (defined as mildly elevated thyrotropin [TSH......) and T(3) estimates) LT(4) treatment resulted in 6% reduction in supine MAP (p treatment (p

Single left coronary ostium and an anomalous prepulmonic right coronary artery in 2 dogs with congenital pulmonary valve stenosis.

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Visser, Lance C; Scansen, Brian A; Schober, Karsten E

2013-06-01

A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme. Copyright © 2013 Elsevier B.V. All rights reserved.

Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

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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

Coronary arterio-venous fistula associated acute coronary syndrome: A case-report and review of literature

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V.H. Contreras-Gutiérrez

2017-01-01

Full Text Available A 56-year-old woman with no medical history presented to the emergency department complaining of oppressive chest pain of three hours of duration triggered by walking. An electrocardiogram (ECG performed at hospital admission showed ST-segment depression and T-wave inversion in left precordial and inferior leads. Serum troponin I levels were above the normal values. Non ST-segment elevation acute coronary syndrome (NSTEACS was diagnosed and an invasive approach with a percutaneous coronary intervention was performed. No obstructive coronary lesions were observed. However a tortuous coronary fistula emerging from the left-anterior descending coronary artery to the pulmonary artery was observed. Coronary arterio-venous fistulas are present in 0.002% of the general population and in 0.25% of patients undergoing cardiac catheterization for any cause. Most of them are asymptomatic. Ischemic symptoms may develop but are infrequent in patients with no atherosclerotic disease.

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

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Stott, David J; Rodondi, Nicolas; Kearney, Patricia M; Ford, Ian; Westendorp, Rudi G J; Mooijaart, Simon P; Sattar, Naveed; Aubert, Carole E; Aujesky, Drahomir; Bauer, Douglas C; Baumgartner, Christine; Blum, Manuel R; Browne, John P; Byrne, Stephen; Collet, Tinh-Hai; Dekkers, Olaf M; den Elzen, Wendy P J; Du Puy, Robert S; Ellis, Graham; Feller, Martin; Floriani, Carmen; Hendry, Kirsty; Hurley, Caroline; Jukema, J Wouter; Kean, Sharon; Kelly, Maria; Krebs, Danielle; Langhorne, Peter; McCarthy, Gemma; McCarthy, Vera; McConnachie, Alex; McDade, Mairi; Messow, Martina; O'Flynn, Annemarie; O'Riordan, David; Poortvliet, Rosalinde K E; Quinn, Terence J; Russell, Audrey; Sinnott, Carol; Smit, Jan W A; Van Dorland, H Anette; Walsh, Kieran A; Walsh, Elaine K; Watt, Torquil; Wilson, Robbie; Gussekloo, Jacobijn

2017-06-29

The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points). The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (PHypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], -2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, -2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest. Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126 .).

Persistence of recruitable coronary collaterals in the absence of coronary vasospasm in a patient with variant angina

International Nuclear Information System (INIS)

Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

1998-01-01

Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

Persistence of Recruitable Coronary Collaterals in the Absence of Coronary Vasospasm in a Patient with Variant Angina

International Nuclear Information System (INIS)

Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

1998-01-01

Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries

Evaluation of hemodynamic significance of coronary fistulae. Diagnostic integration between coronary angiography and stress/rest myocardial scintigraphy

International Nuclear Information System (INIS)

Rubini, G.; Sebastiani, M.

2000-01-01

It is here reported on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography in evaluationing the hemodynamic significance of coronary arteriovenous fistulae. Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, trans thoracic echocardiography, stress electrocardiogram and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography. Stress/rest 99m Tc sestamibi myocardial perfusion single photon tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a seclusive stenosis of the right coronary artery and anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained

Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

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Parag Chevli

2014-09-01

Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

Outcome of in vitro fertilization in women with subclinical hypothyroidism.

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Cai, YunYing; Zhong, LanPing; Guan, Jie; Guo, RuiJin; Niu, Ben; Ma, YanPing; Su, Heng

2017-05-25

Previous studies examining associations between subclinical hypothyroidism (SCH) with in vitro fertilization (IVF) outcome indicate some benefits of levothyroxine (LT4) treatment. But IVF outcomes in treated SCH women whose serum Thyroid Stimulating Hormone (TSH) concentration did and did not exceed 2.5 mIU/L before the IVF cycle has not been studied thoroughly. In this study, we performed a prospective cohort study with 270 treated subclinical hypothyroidism patients undergoing their first IVF retrieval cycle at a single cite. SCH in women receiving LT4 replacement with a basal TSH level between 0.2-2.5mIU/L displayed a similar rate of clinical pregnancy (47.4% vs 38.7%, P = .436), miscarriage (7.4% vs 16.7%, P = .379) and live birth (43.9% vs 32.3%, P = .288) compared to women with a basal TSH level between 2.5-4.2 mIU/L. Strictly controlled TSH (less than 2.5 mIU/L) before IVF may have no effect on the pregnancy rate in LT4 treated SCH women.

Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat

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Barszcz, Karolina; Kupczyńska, Marta; Klećkowska-Nawrot, Joanna; Janeczek, Maciej; Goździewska-Harłajczuk, Karolina; Dzierzęcka, Małgorzata; Janczyk, Paweł

2017-01-01

The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2–18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch), type II (12 animals, 26%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch), type III (11 animals, 23%)–triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%)–double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch). The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat. PMID:29020103

Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography

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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.

High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of the intramural segment

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Biko, David M. [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Chung, Claudia; Chung, Taylor [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Hitt, David M. [Philips Healthcare, Cleveland, OH (United States); Kurio, Gregory [UCSF Benioff Children' s Hospital Oakland, Department of Cardiology, Oakland, CA (United States); Reinhartz, Olaf [UCSF Benioff Children' s Hospital Oakland, Department of Cardiac Surgery, Oakland, CA (United States)

2015-08-15

Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients. To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery. All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment. Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01). MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important

Subclinical delusional ideation and a self-reference bias in everyday reasoning.

Science.gov (United States)

Galbraith, Niall; Manktelow, Ken; Morris, Neil

2008-02-01

Previous studies (e.g. Moller & Husby, 2000; Blackwood et al., 2004) have revealed that delusional thinking is accompanied by an exaggerated focus upon the self and upon stimuli that are perceived to be related to the self. The objective was to examine whether those high in subclinical delusional ideation exhibit a heightened tendency for self-reference. Using a mixed design, healthy individuals, classified into high- and low-scoring groups on the Peters et al. Delusions Inventory (Peters, Day, & Garety, 1996), were compared on everyday reasoning tasks across three experiments. High-PDI scorers, in contrast to the low-PDI group, rated self-referent objections to everyday arguments as stronger than other-referent objections and formulated more self-referent assertion-based objections to everyday arguments. The findings support the notion that subclinical delusional ideation is linked to a self-reference bias, which is evident in the sort of everyday thinking that people engage in when forming or evaluating their beliefs and which may contribute to delusion formation.

Acute phase proteins in bovine milk in an experimental model of Staphylococcus aureus subclinical mastitis

DEFF Research Database (Denmark)

Eckersall, P D; Young, F J; Nolan, A M

2006-01-01

and serum amyloid A increase in serum during mastitis. The concentrations of these proteins were determined in an experimental model using a field strain of Staphylococcus aureus to induce subclinical mastitis in dairy cows. The expression of mRNA coding for these proteins was assessed and the presence of M......The objectives were to establish the origin of 2 acute phase proteins in milk during subclinical bovine mastitis and to characterize the relationship between those proteins in milk and blood. Haptoglobin (Hp) and mammary-associated serum amyloid A (M-SAA3) appear in milk during mastitis, whereas Hp...

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

A multi-level spatial analysis of clinical malaria and subclinical Plasmodium infections in Pailin Province, Cambodia

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Daniel M. Parker

2017-11-01

Full Text Available Background: The malaria burden is decreasing throughout the Greater Mekong Subregion, however transmission persists in some areas. Human movement, subclinical infections and complicated transmission patterns contribute to the persistence of malaria. This research describes the micro-geographical epidemiology of both clinical malaria and subclinical Plasmodium infections in three villages in Western Cambodia. Methods: Three villages in Western Cambodia were selected for the study based on high reported Plasmodium falciparum incidence. A census was conducted at the beginning of the study, including demographic information and travel history. The total population was 1766. Cross-sectional surveys were conducted every three months from June 2013 to June 2014. Plasmodium infections were detected using an ultra-sensitive, high-volume, quantitative polymerase chain reaction (uPCR technique. Clinical episodes were recorded by village health workers. The geographic coordinates (latitude and longitude were collected for all houses and all participants were linked to their respective houses using a demographic surveillance system. Written informed consent was obtained from all participants. Results: Most clinical episodes and subclinical infections occurred within a single study village. Clinical Plasmodium vivax episodes clustered spatially in each village but only lasted for a month. In one study village subclinical infections clustered in geographic proximity to clusters of clinical episodes. The largest risk factor for clinical P. falciparum episodes was living in a house where another clinical P. falciparum episode occurred (model adjusted odds ratio (AOR: 6.9; CI: 2.3–19. 8. Subclinical infections of both P. vivax and P. falciparum were associated with clinical episodes of the same species (AOR: 5.8; CI: 1.5–19.7 for P. falciparum and AOR: 14.6; CI: 8.6–25.2 for P. vivax and self-reported overnight visits to forested areas (AOR = 3.8; CI: 1.8�

Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

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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)

Anatomical studies of the coronary system in elasmobranchs: II. Coronary arteries in hexanchoid, squaloid, and carcharhinoid sharks.

Science.gov (United States)

De Andrés, A V; Muñoz-Chápuli, R; Sans-Coma, V; García-Garrido, L

1992-07-01

Coronary artery anatomy was studied in 16 shark species belonging to 9 families of the orders Hexanchiformes, Squaliformes, and Carcharhiniformes. The study included 101 specimens and used an injection-corrosion technique that obtained internal casts of the main trunks and coronary arterial branches. The results showed 2 main patterns of coronary arterial arrangement: the dorsoventral coronary trunk pattern, shared by lamnoid and advanced carcharhinoid sharks, and the lateral coronary trunk pattern, shown by hexanchoid and squaloid sharks. Scyliorhinus and Galeus had intermediate arrangements of their vessels.

Parasitological Confirmation and Analysis of Leishmania Diversity in Asymptomatic and Subclinical Infection following Resolution of Cutaneous Leishmaniasis.

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Mariana Rosales-Chilama

2015-12-01

Full Text Available The contribution of individuals with subclinical infection to the transmission and endemicity of cutaneous leishmaniasis (CL is unknown. Immunological evidence of exposure to Leishmania in residents of endemic areas has been the basis for defining the human population with asymptomatic infection. However, parasitological confirmation of subclinical infection is lacking.We investigated the presence and viability of Leishmania in blood and non-invasive mucosal tissue samples from individuals with immunological evidence of subclinical infection in endemic areas for CL caused by Leishmania (Viannia in Colombia. Detection of Leishmania kDNA was conducted by PCR-Southern Blot, and parasite viability was confirmed by amplification of parasite 7SLRNA gene transcripts. A molecular tool for genetic diversity analysis of parasite populations causing persistent subclinical infection based on PCR amplification and sequence analysis of an 82bp region between kDNA conserved blocks 1 and 2 was developed.Persistent Leishmania infection was demonstrated in 40% (46 of 114 of leishmanin skin test (LST positive individuals without active disease; parasite viability was established in 59% of these (27 of 46; 24% of total. Parasite burden quantified from circulating blood monocytes, nasal, conjunctival or tonsil mucosal swab samples was comparable, and ranged between 0.2 to 22 parasites per reaction. kDNA sequences were obtained from samples from 2 individuals with asymptomatic infection and from 26 with history of CL, allowing genetic distance analysis that revealed diversity among sequences and clustering within the L. (Viannia subgenus.Our results provide parasitological confirmation of persistent infection among residents of endemic areas of L. (Viannia transmission who have experienced asymptomatic infection or recovered from CL, revealing a reservoir of infection that potentially contributes to the endemicity and transmission of disease. kDNA genotyping

Sub-clinical mastitis prevalent in dairy cows in Chittagong district of Bangladesh: detection by different screening tests

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Mukti Barua

2014-07-01

Full Text Available Aim: Mastitis is recognized as one of the most costly health disorder affecting dairy cows. An epidemiological study was carried out at some selected farms in Chittagong district of Bangladesh to determine the prevalence and risk factors of sub-clinical mastitis (SCM in dairy cows. Materials and Methods: For conducting the study, some dairy farms of Chittagong were selected from urban and periurban areas by stratified random sampling. A total of 444 quarter samples of 111 (56 from commercial dairy farms and 55 from backyards lactating dairy cows were considered. Sub-clinical mastitis (SCM was determined using three different indirect screening tests: California Mastitis Test (CMT, White Slide Test (WST and Surf Field Mastitis Test (SFMT. Sensitivity and specificity were also determined to measure the accuracy of those tests. Results: The prevalence of SCM by CMT, WST and SFMT were 32.43% (n=144, 33.56% (n=149 and 31.53% (n=140, respectively. Distribution of SCM in relation to different variables at quarter level and animal level was also recorded. The prevalence of SCM was significantly (P4 than others at quarter level. No significant difference (P>0.05 was found in relation to breed. Using CMT as a gold standard, sensitivity and specificity of WST and SFMT were also calculated at 95% confidence interval. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and disease prevalence by WST and SFMT were comparable. Conclusion: This study recommends that regular screening of sub-clinical mastitis will reduce the prevalence of sub-clinical mastitis. The most effective way to control sub-clinical mastitis is to take preventive measures such as regular cleaning of the floor, keeping the udder clean, milkman's cleanliness, dry cow therapy specially in high yielding dairy cows.

Parasitological Confirmation and Analysis of Leishmania Diversity in Asymptomatic and Subclinical Infection following Resolution of Cutaneous Leishmaniasis.

Science.gov (United States)

Rosales-Chilama, Mariana; Gongora, Rafael E; Valderrama, Liliana; Jojoa, Jimena; Alexander, Neal; Rubiano, Luisa C; Cossio, Alexandra; Adams, Emily R; Saravia, Nancy G; Gomez, María Adelaida

2015-12-01

The contribution of individuals with subclinical infection to the transmission and endemicity of cutaneous leishmaniasis (CL) is unknown. Immunological evidence of exposure to Leishmania in residents of endemic areas has been the basis for defining the human population with asymptomatic infection. However, parasitological confirmation of subclinical infection is lacking. We investigated the presence and viability of Leishmania in blood and non-invasive mucosal tissue samples from individuals with immunological evidence of subclinical infection in endemic areas for CL caused by Leishmania (Viannia) in Colombia. Detection of Leishmania kDNA was conducted by PCR-Southern Blot, and parasite viability was confirmed by amplification of parasite 7SLRNA gene transcripts. A molecular tool for genetic diversity analysis of parasite populations causing persistent subclinical infection based on PCR amplification and sequence analysis of an 82bp region between kDNA conserved blocks 1 and 2 was developed. Persistent Leishmania infection was demonstrated in 40% (46 of 114) of leishmanin skin test (LST) positive individuals without active disease; parasite viability was established in 59% of these (27 of 46; 24% of total). Parasite burden quantified from circulating blood monocytes, nasal, conjunctival or tonsil mucosal swab samples was comparable, and ranged between 0.2 to 22 parasites per reaction. kDNA sequences were obtained from samples from 2 individuals with asymptomatic infection and from 26 with history of CL, allowing genetic distance analysis that revealed diversity among sequences and clustering within the L. (Viannia) subgenus. Our results provide parasitological confirmation of persistent infection among residents of endemic areas of L. (Viannia) transmission who have experienced asymptomatic infection or recovered from CL, revealing a reservoir of infection that potentially contributes to the endemicity and transmission of disease. kDNA genotyping establishes proof

Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

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Dermot Phelan

Full Text Available In asymptomatic subjects B-type natriuretic peptide (BNP is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS and peripheral serum from patients with low (n = 14 and high BNP (n = 27. Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001. CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008, CITP (r = 0.35, p = 0.03 and PIIINP (r = 0.35, p = 0.001, and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002, IL-6 (r = 0.35, p = 0.04, and IL-8 (r = 0.54, p<0.001. The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007, TNF-α (3.2±0.5 versus 3.7±1.1, p = 003, IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02 and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04, and greater left ventricular mass index (97±20 versus 118±26 g/m(2, p = 0.03 and left atrial volume index (18±2 versus 21±4, p = 0.008. Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

LENUS (Irish Health Repository)

Phelan, Dermot

2012-11-01

In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g\\/m(2), p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

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.)

Optical coherence tomography following percutaneous coronary intervention with Excimer laser coronary atherectomy

Energy Technology Data Exchange (ETDEWEB)

Rawlins, John, E-mail: john.rawlins@doctors.net.uk; Talwar, Suneel; Green, Mark; O’Kane, Peter

2014-01-15

The indications for Excimer laser coronary atherectomy (ELCA) have been refined in modern interventional practice. With the expanding role for optical coherence tomography (OCT) providing high-resolution intra-coronary imaging, this article examines the appearance of the coronary lumen after ELCA. Each indication for ELCA is discussed and illustrated with a clinical case, followed by detailed analysis of the OCT imaging pre and post ELCA. The aim of the article is to provide information to interventional cardiologists to facilitate decision making during PCI, when ELCA has been used as part of the interventional strategy.

Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

DEFF Research Database (Denmark)

Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

2016-01-01

BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary...... microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary.......01), hypertension (P=0.02), current smoking (Ppain characteristics or results from diagnostic stress testing...

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

Clinical research on keratoconus and subclinical keratoconus in patients with astigmatism examined by Pentacam

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Yang An

2016-03-01

Full Text Available AIM: To study the keratoconus(KCNand subclinical KCN in patients with astigmatism ≥2D by Pentacam anterior segment analyzer. METHODS: Two hundred and one eyes in 107 patients with astigmatism ≥2D were included in this study. All patients underwent optometry, visual acuity, corrected visual acuity, slit lamp biomicroscopy, fundus examination, traditional corneal topography and examination with Pentacam. Changes of several parameters were observed including K1(horizontal central curvature within the scope with diameter of 3mm, K2(vertical central curvature within the scope with diameter of 3mm; Kmax(the maximum anterior corneal refractive power, corneal astigmatism(CYL, MinPachy(the thickness at the thinnest area of cornea, index of surface variation(ISV, index of vertical asymmetry(IVA, keratoconus index(KI, height of anterior corneal surface(AEand height of posterior corneal surface(PE, etc. ROC curve was made. Cutoff value and the sensitive index of each group were compared. Mann-Whitney U test was used for analysis of several parameters obtained from Pentacam. ROC curve was analyzed to determine the best diagnosis cutoff value. RESULTS: Mean age of the study population was 25.7±6.6 years old. Kmax, IVA, KI, AE and PE of the clinical and subclinical group were significantly higher than those of the astigmatism group, while the thickness at the thinnest area of cornea in clinical and subclinical group was lower than that of the astigmatism group(PCONCLUSION: The current study shows that subjects with 2D or more of astigmatism, even some of them have normal vision, should undergo corneal topography screening. Pentacam may provide more accurate information about anterior and posterior corneal anatomy especially for the height of posterior corneal surface, which plays an important role in screening of subclinical KCN.

Comparison of Pre and Post-Treatment Orexin A Levels in Patients with Subclinical Hypothyroidism

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Muhammed Erdal

2010-01-01

Full Text Available Aim: Subclinical hypothyroidism is a clinical condition mostly observed in women, the prevalence of which increases by age. Sleepiness and appetite problems are observed in subclinical hypothyroidism. Orexins play a role in the physiological regulations like the stabilization of cardiovascular functions and the sleep-alert cycle. Similarities in the physiological regulation areas of orexins and the clinical findings of hypothyroidism were influential in the planning of this research. Additionally, homosisteine, which is influential on the cardiovascular system and the plasma level of which changes by eating (as is the case with orexins, was also analyzed. Besides, the change in the lipid profiles of the patients was also observed. Material and Methods: Nineteen pre-menopausal female patients (mean age=39.58±12.58, mean BMI= 26.7±4.9 included in this study. Following 12 hours fasting blood samples were taken from brachial vein. All patients were given 50µg/day L-T4 TSH levels were examined in every 4-6 weeks to adjust the L-T4 doses. When euthyroidism was ensured, a re-evaluation was made 4 months later. Results:  Pre-treatment plasma orexin A levels of 19 patients with pre-menopausal subclinical hypothyroidism increased significantly following a treatment of l-tiroxin for 4 months (pre-treatment orexin level median=1.20 mg/dl (mean: 1.33±0.28 post-treatment median=1.82 mg/dl (mean: 1.70±0.42 p=0.007. A significant change in the level of plasma total homosisteine and lipid profile was not detected. Conclusions: Advanced studies are needed to study the physiological effects of orexin levels in cases with subclinical hypothyroidism and the possible benefits in treatment.

Premature subclinical atherosclerosis in children and young adults with juvenile idiopathic arthritis

DEFF Research Database (Denmark)

Bohr, Anna-Helene; Fuhlbrigge, Robert C; Karup Pedersen, Freddy

2016-01-01

Many studies show that Juvenile Idiopathic Arthritis (JIA) is associated with early subclinical signs of atherosclerosis. Chronic inflammation per se may be an important driver but other known risk factors, such as dyslipidemia, hypertension, insulin insensitivity, a physically inactive lifestyle...

Coronary In-Stent Restenosis: Assessment with Corrected Coronary Opacification Difference across Coronary Stents Measured with CT Angiography.

Science.gov (United States)

Gao, Yang; Lu, Bin; Hou, Zhi Hui; Yu, Fang Fang; Yin, Wei Hua; Wang, Zhi Qiang; Wu, Yong Jian; Mu, Chao Wei; Meinel, Felix G; McQuiston, Andrew D; Schoepf, U Joseph

2015-05-01

To determine whether changes in coronary opacification normalized to the aorta (corrected coronary opacification [CCO]) across stents can help identify in-stent restenosis (ISR) severity with use of invasive coronary angiography as the standard of reference. This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The authors retrospectively analyzed 106 patients (88 men, 18 women; mean age, 59.6 years ± 10.4; age range, 36-84 years) who had previously undergone stent implantation within 3 months of coronary computed tomographic (CT) angiography. Attenuation values in the coronary lumen were measured proximal and distal to the stents and normalized to the descending aorta. The CCO difference across the stent was compared with the severity of ISR. One-way analysis of variance least significant difference was used for comparison. A total of 141 stents were assessed. Seventy-six stents were normally patent, 18 had ISR of less than 50%, 28 had ISR of 50%-99%, and 19 were fully occluded. The median CCO differences in the four groups were 0.078, 0.163, 0.346, and 0.606, respectively. There was no significant difference between stents with an ISR of at least 50% and those with total occlusion (P = .056), although the other groups had significant differences at pairwise comparison (P stents smaller than 3 mm in diameter, the median CCO differences in the four groups were 0.086, 0.136, 0.390, and 0.471, respectively. The CCO differences across normal stents and stents with ISR of less than 50% were significantly less than those across stents with an ISR of at least 50% and those with total occlusion (P stents with no ISR and those with an ISR of less than 50% (P = .821) and between stents with an ISR of at least 50% and those with an ISR of 100% (P = .836). The CCO difference across coronary stents is related to ISR severity in obstructive ISR in stents smaller than 3 mm in diameter. © RSNA, 2014.

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

Fatal radiation pneumonia following subclinical busulfan injury

International Nuclear Information System (INIS)

Soble, A.R.; Perry, H.

1977-01-01

A patient with polycythemia vera received a moderate dose (480 mg) of busulfan intermittently over a 6 year period and later developed Hodgkin's disease. Following split-course upper mantle, chest irradiation, he developed rapidly progressive, fatal pneumonia and bone marrow hypoplasia. It is postulated that the hyperacute organ failures (lung and bone marrow) resulted from augmentation of subclinical busulfan-induced damage of these organs by additive radiation effect. It is recommended that in patients who have had antineoplastic chemotherapy, major radiotherapy to the cervicothoracic region be accompanied by careful monitoring of respiratory and hematopoietic function, both before and during radiotherapy

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...

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)

Recurrent exposure to subclinical lipopolysaccharide increases mortality and induces cardiac fibrosis in mice.

Directory of Open Access Journals (Sweden)

Wilbur Y W Lew

Full Text Available BACKGROUND: Circulating subclinical lipopolysaccharide (LPS occurs in health and disease. Ingesting high fatty meals increases LPS that cause metabolic endotoxemia. Subclinical LPS in periodontal disease may impair endothelial function. The heart may be targeted as cardiac cells express TLR4, the LPS receptor. It was hypothesized that recurrent exposure to subclinical LPS increases mortality and causes cardiac fibrosis. METHODS: C57Bl/6 mice were injected with intraperitoneal saline (control, low dose LPS (0.1 or 1 mg/kg, or moderate dose LPS (10 or 20 mg/kg, once a week for 3 months. Left ventricular (LV function (echocardiography, hemodynamics (tail cuff pressure and electrocardiograms (telemetry were measured. Cardiac fibrosis was assessed by picrosirius red staining and LV expression of fibrosis related genes (QRT-PCR. Adult cardiac fibroblasts were isolated and exposed to LPS. RESULTS: LPS injections transiently increased heart rate and blood pressure (<6 hours and mildly decreased LV function with full recovery by 24 hours. Mice tolerated weekly LPS for 2-3 months with no change in activity, appearance, appetite, weight, blood pressure, LV function, oximetry, or blood chemistries. Mortality increased after 60-90 days with moderate, but not low dose LPS. Arrhythmias occurred a few hours before death. LV collagen fraction area increased dose-dependently from 3.0±0.5% (SEM in the saline control group, to 5.6±0.5% with low dose LPS and 9.7±0.9% with moderate dose LPS (P<0.05 moderate vs low dose LPS, and each LPS dose vs control. LPS increased LV expression of collagen Iα1, collagen IIIα1, MMP2, MMP9, TIMP1, periostin and IL-6 (P<0.05 moderate vs low dose LPS and vs control. LPS increased α-SMA immunostaining of myofibroblasts. LPS dose-dependently increased IL-6 in isolated adult cardiac fibroblasts. CONCLUSIONS: Recurrent exposure to subclinical LPS increases mortality and induces cardiac fibrosis.

Hemodynamic analysis of sequential graft from right coronary system to left coronary system.

Science.gov (United States)

Wang, Wenxin; Mao, Boyan; Wang, Haoran; Geng, Xueying; Zhao, Xi; Zhang, Huixia; Xie, Jinsheng; Zhao, Zhou; Lian, Bo; Liu, Youjun

2016-12-28

Sequential and single grafting are two surgical procedures of coronary artery bypass grafting. However, it remains unclear if the sequential graft can be used between the right and left coronary artery system. The purpose of this paper is to clarify the possibility of right coronary artery system anastomosis to left coronary system. A patient-specific 3D model was first reconstructed based on coronary computed tomography angiography (CCTA) images. Two different grafts, the normal multi-graft (Model 1) and the novel multi-graft (Model 2), were then implemented on this patient-specific model using virtual surgery techniques. In Model 1, the single graft was anastomosed to right coronary artery (RCA) and the sequential graft was adopted to anastomose left anterior descending (LAD) and left circumflex artery (LCX). While in Model 2, the single graft was anastomosed to LAD and the sequential graft was adopted to anastomose RCA and LCX. A zero-dimensional/three-dimensional (0D/3D) coupling method was used to realize the multi-scale simulation of both the pre-operative and two post-operative models. Flow rates in the coronary artery and grafts were obtained. The hemodynamic parameters were also showed, including wall shear stress (WSS) and oscillatory shear index (OSI). The area of low WSS and OSI in Model 1 was much less than that in Model 2. Model 1 shows optimistic hemodynamic modifications which may enhance the long-term patency of grafts. The anterior segments of sequential graft have better long-term patency than the posterior segments. With rational spatial position of the heart vessels, the last anastomosis of sequential graft should be connected to the main branch.

Intraoperative echocardiographic imaging of coronary arteries and graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass.

Science.gov (United States)

Suematsu, Y; Takamoto, S; Ohtsuka, T

2001-12-01

No accepted approach exists for the intraoperative evaluation of the quality of coronary arteries and the technical adequacy of graft anastomoses during coronary artery bypass grafting without cardiopulmonary bypass. We assessed the accuracy of high-frequency epicardial echocardiography and power Doppler imaging in evaluating coronary arteries during coronary artery bypass grafting without cardiopulmonary bypass. To validate measurements of coronary arteries and graft anastomoses by high-frequency epicardial echocardiography and power Doppler imaging, we compared luminal diameters determined by these methods with diameters determined histologically in a study of off-pump coronary artery bypass grafting in 20 dogs. Technical errors were deliberately created in 10 grafts (stenosis group). The results of these animal validation studies showed that the maximum luminal diameters of coronary arteries and graft anastomoses measured by high-frequency epicardial echocardiography (HEE) and power Doppler imaging (PDI) correlated well with the histologic measurements: HEE = 1.027 x Histologic measurements + 0.005 (P anastomoses were examined intraoperatively by high-frequency epicardial echocardiography and power Doppler imaging, and luminal diameters determined by power Doppler imaging were compared with those determined by postoperative coronary angiography. The results demonstrated that graft anastomosis by power Doppler imaging correlated well with the angiographic measurements: PDI = 1.018 x Angiographic measurements - 0.106 (P anastomoses and can detect technical errors and inadequacies during coronary artery bypass grafting without cardiopulmonary bypass.

Subclinical thyrotoxicosis in an outpatient population - predictors of outcome.

Science.gov (United States)

Schouten, Belinda J; Brownlie, Bevan E W; Frampton, Chris M; Turner, John G

2011-02-01

Individuals with endogenous subclinical thyrotoxicosis (SCT) may subsequently require treatment for overt disease. We aimed to evaluate the frequency of progression to hyperthyroidism and factors influencing this outcome. This is a retrospective analysis of outcome in 96 consecutive patients (aged 16-91 years) diagnosed with SCT over a 6-year period. Individuals with secondary causes of TSH suppression were excluded. Mean follow-up was 3·8 years. The significance of age, gender, family history of thyrotoxicosis, symptoms at presentation, thyroid nodule(s) on clinical examination, entry TSH level, antithyroid antibody status and (99m) Tc pertechnetate thyroid imaging results on subsequent development of overt thyrotoxicosis was assessed. Progression to overt thyrotoxicosis was seen in 8% at 1 year, 16% at 2 years, 21% at 3 years and 26% at 5 years. Multivariate analysis determined that diagnosis as determined by scintiscan to be the only independent predictor of outcome (P = 0·003) with the cumulative percentage requiring therapy at 5 years being 9% for subclinical Graves' disease, 21% for multinodular goitre and 61% for the autonomous nodule subgroup. Progression of SCT to overt hyperthyroidism occurred at a rate of 5-8% per year with disease aetiology, as determined by thyroid scintigraphy, significantly influencing risk of progression. © 2011 Blackwell Publishing Ltd.

Coronary artery atherosclerosis associated with shift work in chemical plant workers by using coronary CT angiography.

Science.gov (United States)

Kang, WonYang; Park, Won-Ju; Jang, Keun-Ho; Kim, Soo-Hyeon; Gwon, Do-Hyeong; Lim, Hyeong-Min; Ahn, Ji-Sung; Moon, Jai-Dong

2016-08-01

The aim of this study was to investigate whether shift work is related to elevated risk of coronary artery disease (CAD) by determining the coronary artery calcium (CAC) score and the presence of coronary artery stenosis by using coronary artery CT angiography (CCTA). In this study, 110 male workers participated and underwent a CCTA examination for CAC scoring, which represents coronary artery plaque, and were evaluated for luminal stenosis. All of the participants were working in the same chemical plant, of whom 70 worked day shifts and 40 worked rotating shifts. In a multivariate logistic regression analysis, including age, smoking status, alcohol consumption, regular exercise and waist circumference, shift work was associated with a 2.89-fold increase in the odds of developing coronary plaque compared with day work (OR, 2.89; 95% CI 1.07 to 7.82). The association between shift work and coronary plaque was strong after adjustment for age, low-density lipoprotein cholesterol, hypertension and diabetes mellitus (OR, 2.92; 95% CI 1.02 to 8.33). In addition, the number of years of shift work employment was associated with coronary plaque. However, no association was found between shift work and coronary artery stenosis. Shift work could induce CAD onset via the atherosclerotic process, and shift work employment duration was associated with an increased risk of atherosclerosis in male workers. 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/

Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease

International Nuclear Information System (INIS)

Meng, Lingdong; Cui, Lianqun; Cheng, Yuntao; Wu, Xiaoyan; Tang, Yuansheng; Wang, Yong; Xu, Fayun

2009-01-01

To evaluate the diagnostic accuracy of a dual-source computed tomography (DSCT) coronary angiography, with a particular focus on the effect of heart rate and calcifications. One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate ( 400). Next, the effect of heart rate and calcification on the accuracy of coronary artery stenosis detection was analyzed by using an invasive coronary angiography as a reference standard. Coronary segments of less than 1.5 mm in diameter in an American Heart Association (AHA) 15-segment model were independently assessed. The mean heart rate during the scan was 71.8 bpm, whereas the mean Agatston score was 226.5. Of the 1,588 segments examined, 1,533 (97%) were assessable. A total of 17 patients had calcium scores above 400 Agatston U, whereas 50 had heart rates ≥ 70 bpm. Overall the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for significant stenoses were: 95%, 91%, 65%, and 99% (by segment), respectively and 97%, 90%, 81%, and 91% (by artery), respectively (n = 475). Heart rate showed no significant impact on lesion detection; however, vessel calcification did show a significant impact on accuracy of assessment for coronary segments. The specificity, PPV and accuracy were 96%, 80%, and 96% (by segment), respectively for an Agatston score less than 100% and 99%, 96% and 98% (by artery). For an Agatston score of greater to or equal to 400 the specificity, PPV and accuracy were reduced to 79%, 55%, and 83% (by segment), respectively and to 79%, 69%, and 85% (by artery), respectively. The DSCT provides a high rate of accuracy for the detection of significant coronary artery disease, even in patients with high heart rates and evidence of coronary calcification. However, patients with severe coronary calcification (> 400 U) remain a challenge to diagnose

Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

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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.

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

Association between the surfactant protein D (SFTPD) gene and subclinical carotid artery atherosclerosis

DEFF Research Database (Denmark)

Sorensen, Grith L; Bladbjerg, Else Marie; Steffensen, Rudi

2016-01-01

OBJECTIVE: Surfactant protein D (SP-D) is a defense collectin with inflammation-modulating properties. SP-D deficiency inhibits atherosclerosis in vivo, and the circulatory SP-D levels have been previously associated with cardiovascular disease mortality. We hypothesized that plasma SP-D (p......SP-D) and SP-D gene (SFTPD) single nucleotide polymorphisms (SNPs) are risk factors for atherosclerosis. METHODS: We evaluated individuals who were all 60 years old and participated in The Glostrup Population Study. Subclinical atherosclerosis was diagnosed based on the ultrasonographic measurement of intima......: The results do not support that pSP-D levels influence the development of subclinical atherosclerosis. However, the SFTPD SNP data support previous observations from animal studies that SP-D plays a role in the etiology of atherosclerotic disease development. The nominal significant effects are likely...

High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device.

Science.gov (United States)

Wilke, Iris; Witzel, Katrin; Münch, Julia; Pecha, Simon; Blankenberg, Stephan; Reichenspurner, Hermann; Willems, Stephan; Patten, Monica; Aydin, Ali

2016-07-01

Atrial fibrillation (AF) is an important prognostic parameter in patients with hypertrophic cardiomyopathy (HCM). Though cardiac rhythm management (CRM) devices (e.g., ICD, pacemaker or implantable loop recorder) can detect subclinical AF, data describing the incidence of AF are rare. We therefore investigated the incidence and clinical impact of de novo and subclinical AF detected by CRM devices in patients with HCM. In our retrospective single-center study, we included patients with HCM and need for CRM devices. The primary endpoint of the study was the incidence of clinical and subclinical de novo AF. During follow-up, patients were screened for adverse events like stroke, ventricular arrhythmia, heart failure, or death. From 192 HCM patients, 44 patients received a CRM device (38 ICDs, 5 pacemakers, 1 implantable loop recorder). In 14 of these patients (32%), AF had been documented before device implantation. Thirty (68%) patients were free from AF at the time of implantation. During a median follow-up of 595 days (interquartile range, 367-890 days), de novo AF was recorded in 16 of these 30 patients (53%). Fourteen (88%) of the 16 patients with de novo AF were free from any clinical symptoms, so these patients were classified to have subclinical AF. In logistic regression analysis, age was the only significant predictor for an increased risk of AF. AF is common in patients with HCM who need a CRM device. More than 50% of these patients develop de novo AF that was predominantly subclinical in our cohort. © 2016 Wiley Periodicals, Inc.

Intraarterial digital subtraction angiography after coronary bypass surgery - an alternative to coronary angiography

International Nuclear Information System (INIS)

Hauenstein, H.K.; Roeren, T.; Schlosser, V.; Urbani, B.

1985-01-01

Intraarterial digital subtraction angiography after coronary bypass surgery - an alternative to coronary angiography. Intraarterial DSA is a suitable method for early postoperative control of coronary artery bypass grafts. Small quantities of contrast media with low iodine content are injected into the aortic root. Investigations can be carried out with a routine fluoroscopic and digital equipment; additional cine-technique and analogue memory disc are not necessary. At an image rate of 3/s the bypass anastomoses can be exactly visualized in 75%, whereas diagnostic information was not sufficient in only 4% of all cases. The use of modern F-5-catheters and the nonselective injection make this method a less invasive alternative to coronary angiography. It is paticularly useful in evaluation of short- and long-term results. (orig.) [de

Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves

DEFF Research Database (Denmark)

Makkar, Raj R; Fontana, Gregory; Jilaihawi, Hasan

2015-01-01

BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis...... patients and 1 of 115 patients, respectively; P=0.007). CONCLUSIONS: Reduced aortic-valve leaflet motion was shown in patients with bioprosthetic aortic valves. The condition resolved with therapeutic anticoagulation. The effect of this finding on clinical outcomes including stroke needs further...

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...

Coronary artery disease confined to secondary branches of the left coronary system