18 research outputs found
Left ventricular twist mechanics and its relation with aortic stiffness in chronic kidney disease patients without overt cardiovascular disease.
BACKGROUND: Recent studies hypothesized left ventricular (LV) twist as a potential biomarker for evaluation of sub clinical myocardial disease, however its relationship with aortic stiffness has yet to be investigated. Chronic kidney disease (CKD) has been identified as a risk factor for both myocardial and arterial disease. As such we sought to explore the relationship between aortic stiffness and LV twist in CKD patients without known cardiovascular disease (CVD). METHODS: In this prospective, observational study we enrolled 106 CKD patients (Stages 1 to 5) with normal LVEF as assessed by conventional echocardiography. Aortic stiffness was measured using aortic pulse wave velocity (aPWV). We defined increased aPWV as ≥10 m/s. LV Twist was measured using two-dimensional speckle tracking echocardiography. RESULTS: Patients with increased aPWV had higher LV twist (p = 0.002) but similar LVEF (p = 0.486). Aortic PWV correlated crudely with age (p < 0.001), the presence of diabetes (p < 0.001), hypertension (p < 0.001), eGFR (p < 0.001), LVMI (p = 0.01), e/e’ (p < 0.001) and LV twist (p = 0.003). In multivariable analyses after adjusting for age, gender, cardiovascular risk factors and hypertensive medication, aPWV was independently associated with LV twist (β = 0.163, p = 0.025). CONCLUSIONS: Aortic stiffness independently associates with LV Twist in asymptomatic CKD patients. These findings suggest a close interaction between LV twist mechanics and arterial remodeling even before CVD becomes clinically relevant
Personal health records in the preclinical medical curriculum: modeling student responses in a simple educational environment utilizing Google Health
Abstract Background Various problems concerning the introduction of personal health records in everyday healthcare practice are reported to be associated with physicians’ unfamiliarity with systematic means of electronically collecting health information about their patients (e.g. electronic health records - EHRs). Such barriers may further prevent the role physicians have in their patient encounters and the influence they can have in accelerating and diffusing personal health records (PHRs) to the patient community. One way to address these problems is through medical education on PHRs in the context of EHR activities within the undergraduate medical curriculum and the medical informatics courses in specific. In this paper, the development of an educational PHR activity based on Google Health is reported. Moreover, student responses on PHR’s use and utility are collected and presented. The collected responses are then modelled to relate the satisfaction level of students in such a setting to the estimation about their attitude towards PHRs in the future. Methods The study was conducted by designing an educational scenario about PHRs, which consisted of student instruction on Google Health as a model PHR and followed the guidelines of a protocol that was constructed for this purpose. This scenario was applied to a sample of 338 first-year undergraduate medical students. A questionnaire was distributed to each one of them in order to obtain Likert-like scale data on the sample’s response with respect to the PHR that was used; the data were then further analysed descriptively and in terms of a regression analysis to model hypothesised correlations. Results Students displayed, in general, satisfaction about the core PHR functions they used and they were optimistic about using them in the future, as they evaluated quite high up the level of their utility. The aspect they valued most in the PHR was its main role as a record-keeping tool, while their main concern was related to the negative effect their own opinion might have on the use of PHRs by patients. Finally, the estimate of their future attitudes towards PHR integration was found positively dependent of the level of PHR satisfaction that they gained through their experience (rho = 0.524, p Conclusions The results indicate that students support PHRs as medical record keeping helpers and perceive them as beneficial to healthcare. They also underline the importance of achieving good educational experiences in improving PHR perspectives inside such educational activities. Further research is obviously needed to establish the relative long-term effect of education to other methods of exposing future physicians to PHRs.</p
Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD
An integrated assessment of family history on the risk of developing acute coronary syndromes (CARDIO2000 Study)
Objective - In this work we assessed a risk score for developing a first
event of acute coronary syndrome (ACS) based on the family history of
the cardiovascular risk factors.
Methods and results - The studied population consisted of 848 randomly
selected middle-aged patients with first event of ACS and 1078
sex-age-region matched controls admitted to the same hospitals for minor
operations and without any clinical suspicion of cardiovascular disease
in their life. A Family History Score (FHS) was developed based on the
presence of coronary heart disease, hypertension, hypercholesterolaemia
and diabetes mellitus, among first-degree relatives of the participants
after adjusting for the family size. The evaluation of FHS was based on
conditional logistic regression analysis, after controlling for
demographic variables as well as for the mutual confounding effects of
other risk factors. Family history of CHD, hypercholesterolaemia and
diabetes was highly associated with the development of the disease. The
introduced FHS was also highly associated with the development of ACS
among participants who had no family history of CHD (odds ratio = 10.9,
p < 0.001), whereas it was not associated with the development of the
disease among participants who had a family history of CHD (odds ratio =
1.41, p = 0.543).
Conclusions - The suggested FHS could be a useful tool in the primary
prevention of ACS, as well as in detecting and understanding
associations between genetic vulnerability and cardiovascular risk
factors
Towards a graph theoretical approach to study gender lateralization effect in mathematical thinking
Gender differences in mathematical thinking is a common concern of scientists from different research fields. Both parents and teachers report that males seem to perform better in complex mathematics compared to females. This study comes to shed light in the different organization of the underlying functional networks, in order to investigate the aforementioned observation, without supporting or rejecting this statement. In this sense, it is generally accepted that females use their both hemispheres to accomplish a certain task, while males use mostly the hemisphere which is properly suited. For the purposes of the current analysis, electroencephalographic recordings were collected from 11 males and 11 females, during a difficult mathematical task. Then a previously proposed model was used in order to pass from the sensor level to the cortical one, in order to examine the networks formed among the cortical dipoles. Mutual information was employed to form the graphs represeting the functional connectivity among the different dipoles, while the density, the global and the local efficiencies were further examined. The results suggest that females use their both hemisphere to solve the complex mathematical task while males use mostly their left hemisphere which is the responsible one for the mathematical thinking
Acute systemic inflammation induced by influenza A (H1N1) vaccination causes a deterioration in endothelial function in HIV-infected patients
Objectives
Vaccination of HIV-infected patients against the influenza A/H1N1
subtype was proposed as a mandatory precautionary measure during the
2009 pandemic. The immediate cardiovascular effects of the novel vaccine
have been largely unexplored. We investigated the impact of vaccination
on indices of endothelial function in a cohort of HIV-infected patients.
Methods
We included 24 HIV-infected patients in a study with a randomized, sham
procedure-controlled design. A monovalent, adjuvanted vaccine against
influenza A/H1N1 was used in the vaccine arm (n = 16); patients in the
control group (n = 8) were subjected to a sham procedure. Endothelial
function, as assessed by flow-mediated dilatation (FMD), and
inflammatory markers were assessed prior to and 8 and 48 h post
vaccination.
Results
FMD deteriorated following vaccination (baseline, 6.5 +/- 1.1%; 8 h,
1.1 +/- 1.5%; 48 h, 2.0 +/- 1.4%; P = 0.04). The white blood cell
count increased at 8 h and remained elevated at 48 h. Soluble
intercellular adhesion molecule-1 levels decreased after vaccination;
the maximum decrease was noted at 48 h. Conversely, the sham procedure
did not induce changes in endothelial function or inflammatory markers,
apart from a reduction in the white blood cell count at 48 h.
Conclusions
Acute systemic inflammation induced by vaccination against the influenza
A/H1N1 virus resulted in a deterioration in endothelial function in
HIV-infected patients, and this effect was sustained for at least 48 h.
Our findings may have important implications in view of the high
cardiovascular risk that HIV infection carries. The effect of the novel
vaccine on endothelial function should be weighed against the
immunological protection that it confers