EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond

These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/P-SPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/P-SPECT an essential method for the diagnosis of PE. When V/P-SPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/P-SPECT interpretation are discussed. In conclusion, V/P-SPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.Peer reviewe

Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay

Background: We sought to investigate sex-related differences in access to care among patients with myocardial infarction (STEMI) in order to identify gender-related factors associated with outcomes. Methods: We studied 7457 patients enrolled in the ISACS-TC registry 2010-2014 (ClinicalTrials.gov NCT01218776). Outcome measures were: inhospital mortality, time delay to call emergency medical services (EMS), home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset. Constant variables included in logistic regression analyses were: age, risk factors, severity of clinical presentation, reperfusion therapies, and concurrent acute medications. Time to treatment from symptom onset was used as dummy variable. Results: Women were less likely than men to receive care within the benchmark time for reperfusion therapy (time to treatment from symptom onset 60 min in 70.3% of women vs 29.7% of men. There were no significant differences in door-to-needle (median; 28 min vs 26 min) and door-to-balloon (median: 45 min vs 45 min) times. Major (z >4)determinants of poorer rates of reperfusion therapies included time to treatment from symptom onset >12 hours (adjusted OR: 5.37, CI: 4.58 - 6.31) Killip class > 2 (OR: 1.53, CI: 1.27-1.86) and history of prior heart failure (OR: 2.77, CI, 1.99 to 3.87). After adjustment, women had greater inhospital mortality rates than men (OR: 1.34, CI: 1.01-1.77). Sex differences in in-hospital mortality rates were no longer observed in the cohort, when time to treatment from symptom onset <12 hours was included in the multivariable analysis (OR: 1.31, CI: 0.98 -1.74). Conclusion: Sex differences in outcomes persist among STEMI patients, as fewer women receive timely reperfusion therapy. Pre-hospital delays in women experiencing STEMI remain unacceptably long

Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay

Background: We sought to investigate sex-related differences in access to care among patients with myocardial infarction (STEMI) in order to identify gender-related factors associated with outcomes. Methods: We studied 7457 patients enrolled in the ISACS-TC registry 2010-2014 (ClinicalTrials.gov NCT01218776). Outcome measures were: inhospital mortality, time delay to call emergency medical services (EMS), home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset. Constant variables included in logistic regression analyses were: age, risk factors, severity of clinical presentation, reperfusion therapies, and concurrent acute medications. Time to treatment from symptom onset was used as dummy variable. Results: Women were less likely than men to receive care within the benchmark time for reperfusion therapy (time to treatment from symptom onset 60 min in 70.3% of women vs 29.7% of men. There were no significant differences in door-to-needle (median; 28 min vs 26 min) and door-to-balloon (median: 45 min vs 45 min) times. Major (z >4)determinants of poorer rates of reperfusion therapies included time to treatment from symptom onset >12 hours (adjusted OR: 5.37, CI: 4.58 - 6.31) Killip class > 2 (OR: 1.53, CI: 1.27-1.86) and history of prior heart failure (OR: 2.77, CI, 1.99 to 3.87). After adjustment, women had greater inhospital mortality rates than men (OR: 1.34, CI: 1.01-1.77). Sex differences in in-hospital mortality rates were no longer observed in the cohort, when time to treatment from symptom onset <12 hours was included in the multivariable analysis (OR: 1.31, CI: 0.98 -1.74). Conclusion: Sex differences in outcomes persist among STEMI patients, as fewer women receive timely reperfusion therapy. Pre-hospital delays in women experiencing STEMI remain unacceptably long

Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. ----- METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. ----- RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of 9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. ----- CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease

Data sharing: A new editorial initiative of the international committee of medical journal editors. Implications for the editors´ network

The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiolog

Data sharing: A new editorial initiative of the international committee of medical journal editors. Implications for the editors´ network

The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiolog

Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

Background: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods: The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed 6 months after the start of medication. Results: A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index 30 kg/m2 ) and 63.8% centrally obese (waist circumference 88 cm for women, 102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion: The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial

Left bundle branch block (LBBB) in patients with heart failure (HF) in Mostar region of Bosnia and Herzegovina.

UNLABELLED WORK GOAL: to determine the influence of Left branch block Hissa (LBBB) on: (a) the degree of heart weakness according to NYHA classification; (b) structural remodelling based on echocardiographic, and (c) functional remodelling based on EFLV i FS (echo), comparing patients with heart failure (HF) and the left branch block Hissa (LBBB) on EKG with heart failure with heart failure (HF) without the left branch block Hissa (LBBB). METHODS AND WORK We selected group of So hospital patients with heart weakness of NYHA class II-IV with and 50 without the left branch block Hissa on EKG (LBBB). RESULTS There was a clinical and echocardiographic evaluation of all patients and we determined their correlation related to the sex, NYHA class, structural and functional remodelling of heart cavities, EFLV, FS and survival and the number of hospitalisation in the last three years. The results where shown in a form of a table SAS 9.13 was used for statistic analysis. DISCUSSION AND CONCLUSION LBBB is an important component of electric heart remodeling in patients with heart failure and represent an important clinic data in evaluation of patients and therapeutic approach. Because all our variables were expressed as a frequencies, chi square and Fisher exact test were used to test for potential differences. It particularly stressed the correlation of LBBB with echocardiographic movability parameters of i.v. septum and left atrium dimension (p < 0.001) while septum fibrosis (p < 0.001), paradoxal septum movability (p = 0.193) and EFLV (p < 0.001) point to a close correlation with LBBB. Other analysed parameters showed no correlation with LBBB