Significance of high sensitivity C-reactive protein and D-dimer in evaluating intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography: A prospective study

Background: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. Methods and Results: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. Conclusions: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies

Association Between Myocardial Ischemia, Microvascular Function and Patient-Reported Angina

Title from PDF of title page viewed May 16, 2019Thesis advisor: Julie BanderasVitaIncludes bibliographical references (pages 27-30)Thesis (M.S.)--School of Medicine. University of Missouri--Kansas City, 2019Prior studies have not found an association between myocardial ischemia and measures of health status. Whether positron emission tomography (PET)-derived coronary flow reserve (CFR) would be better correlated with burden of angina is currently unknown. Understanding the relationship between myocardial ischemia, flow reserve and health status may illuminate how these variables can be used to inform post-test decisions. Patients with known CAD referred for a clinically-indicated vasodilator PET myocardial perfusion imaging (MPI) between June 2009 and August 2013 who completed the Seattle Angina Questionnaire (SAQ) at the time of MPI and had available CFR data were identified. Angina frequency was determined using SAQ Angina Frequency scores according to previously published thresholds (none, monthly or weekly/daily; SAQ scores of 100, 61 99 and ≤ 60, respectively). The association between CFR and angina frequency was determined after adjusting for age, gender, and the presence of ischemia using ordinal logistic regression. A total of 171 patients met inclusion criteria (mean age 66.3 ± 10.2 years; 61% men). Angina occurred on daily to weekly basis in 44 (25.7%) patients and monthly in 77 (45%) patients. Unadjusted mean CFR did not vary significantly across the spectrum of anginal burden (P=0.28). In the adjusted model, there was a significant interaction between ischemia and CFR (P value = 0.015), such that higher CFR was associated with lower angina frequency only in patients with ischemia (OR per 1-unit increase in CFR 0.45 (95% CI [0.26 0.83], p=0.007), but not in those without ischemia (OR 1.10 (95% CI [0.63-2.00], p=0.85). PET-derived CFR modulates the association between the presence of ischemia and the frequency of patient-reported angina, and complements ischemia in identifying patients with greater frequency of angina.Introduction -- Methods -- Results -- Discussion -- Conclusion -- Appendi

Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on cardiovascular risk in type 2 diabetes mellitus

Patients with type 2 diabetes mellitus (DM) have a very high risk for major adverse cardiovascular (CV) events. Previous studies have shown that traditional oral diabetic medications, despite lowering blood glucose levels, generally do not improve CV outcomes. The safety of some oral hypoglycemic medications has been questioned. We aimed to evaluate the CV safety of dipeptidyl peptidase-4 (DPP4) inhibitors, a novel class of oral diabetic medications, by performing a meta-analysis of DPP4 inhibitors for type 2 DM. A search of electronic databases of published and unpublished literature (until September 30, 2011) was performed to identify randomized controlled trials o

Outcomes of Transcatheter Aortic Valve Replacement in the United Arab Emirates: Real-world, Single-centre Experience from an Emerging Programme

Background: Data on outcomes of transcatheter aortic valve replacement (TAVR) in the Middle East, particularly in the United Arab Emirates (UAE), are limited. Whether centres with a low volume of patients requiring the procedure can achieve similar outcomes as those reported in pivotal clinical trials remains unclear. This study evaluates procedural outcomes of patients undergoing TAVR in a newly established programme in the UAE. Methods: Procedural outcomes of consecutive patients who underwent transfemoral TAVR at a single centre in the UAE between January 2016 and November 2021 were compared with those at centres in the lowest quartile (Q1) of procedural volume in the Transcatheter Valve Therapy Registry, which covers centres in the US. Results: Among the 183 patients included in the study, the median age was 76 years (interquartile range [IQR] 71–82), and 42.1% of patients were women, with a median Society of Thoracic Surgeons predicted risk of mortality score of 4.6 (IQR 2.9–7.5). Most of the patients (93.3%) received a balloon expandable valve. All-cause death within 30 days, stroke and major vascular complications occurred in 0.6%, 0.6% and 2.2% of patients, respectively, compared with 3.1%, 2.2% and 4% in patients treated at Q1 hospitals. Conclusion: Patients undergoing transfemoral TAVR at an emerging centre in the Middle East had favourable outcomes compared with those performed at Q1 hospitals in the US. These findings suggest that careful patient selection for TAVR is critical and may help optimise patient outcomes, especially when procedural volumes are low