Exercise-induced left bundle branch block and subsequent mechanical left ventricular dyssynchrony -resolved with pharmacological therapy

A 53-year-old man with depressed ejection fraction (EF) of 35% and QRS width of 88 ms at rest was admitted to our institution with a complaint of exertional chest discomfort and dyspnea. During treadmill exercise, left bundle-branch block (LBBB) with a QRS width of 152 ms occurred at a heart rate of 100 bpm. During LBBB, the patient showed significant mechanical dyssynchrony as evidenced by a two-dimensional speckle tracking radial strain of 260 ms (≥130 ms), defined as the time difference between anterior-septum and posterior wall. Five-month after carvedilol and candesartan administration, EF had improved to 49% and LBBB did not occur until a heart rate of 126 bpm was attained during treadmill exercise. It appears that pharmacological therapy may be useful for patients with heart failure and exercise-induced LBBB

Cigarette smoking and tooth loss experience among young adults: a national record linkage study

<p>Abstract</p> <p>Background</p> <p>Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20–39 years using linked data from two national databases in Japan.</p> <p>Methods</p> <p>Two databases of the National Nutrition Survey (NNS) and the Survey of Dental Diseases (SDD), which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E.</p> <p>Results</p> <p>Smoking rates differed greatly in men (53.3%) and women (15.5%). The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women). Tooth loss occurred more frequently among current smokers (40.6%) than former (23.1%) and non-smokers (27.9%). Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40–3.50], P = 0.0007) and women (1.70 [1.13–2.55], P = 0.0111). A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend < 0.0001 and 0.0004 in men and women, respectively). Current smoking was also associated with the prevalence of decayed teeth (1.67 [1.28–2.20], P = 0.0002).</p> <p>Conclusion</p> <p>An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to limitations of the available variables in the present databases, further studies including caries experience and its confounders should be conducted to examine whether smoking is a true risk of premature tooth loss in young adults.</p

Gene Knock-Outs of Inositol 1,4,5-Trisphosphate Receptors Types 1 and 2 Result in Perturbation of Cardiogenesis

Rs in cardiogenesis remain unclear.Rs mimicked the phenotype of the AV valve defect that result from the inhibition of calcineurin, and it could be rescued by constitutively active calcineurin.Rs in cardiogenesis in part through the regulation of calcineurin-NFAT signaling

Strain dyssynchrony index determined by three-dimensional speckle area tracking can predict response to cardiac resynchronization therapy

<p>Abstract</p> <p><b>Background</b></p> <p>We have previously reported strain dyssynchrony index assessed by two-dimensional speckle tracking strain, and a marker of both dyssynchrony and residual myocardial contractility, can predict response to cardiac resynchronization therapy (CRT). A newly developed three-dimensional (3-D) speckle tracking system can quantify endocardial area change ratio (area strain), which coupled with the factors of both longitudinal and circumferential strain, from all 16 standard left ventricular (LV) segments using complete 3-D pyramidal datasets. Our objective was to test the hypothesis that strain dyssynchrony index using area tracking (ASDI) can quantify dyssynchrony and predict response to CRT.</p> <p><b>Methods</b></p> <p>We studied 14 heart failure patients with ejection fraction of 27 ± 7% (all≤35%) and QRS duration of 172 ± 30 ms (all≥120 ms) who underwent CRT. Echocardiography was performed before and 6-month after CRT. ASDI was calculated as the average difference between peak and end-systolic area strain of LV endocardium obtained from 3-D speckle tracking imaging using 16 segments. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, Yu Index, and two-dimensional radial dyssynchrony by speckle-tracking strain. Response was defined as a ≥15% decrease in LV end-systolic volume 6-month after CRT.</p> <p>Results</p> <p>ASDI ≥ 3.8% was the best predictor of response to CRT with a sensitivity of 78%, specificity of 100% and area under the curve (AUC) of 0.93 (p < 0.001). Two-dimensional radial dyssynchrony determined by speckle-tracking strain was also predictive of response to CRT with an AUC of 0.82 (p < 0.005). Interestingly, ASDI ≥ 3.8% was associated with the highest incidence of echocardiographic improvement after CRT with a response rate of 100% (7/7), and baseline ASDI correlated with reduction of LV end-systolic volume following CRT (r = 0.80, p < 0.001).</p> <p><b>Conclusions</b></p> <p>ASDI can predict responders and LV reverse remodeling following CRT. This novel index using the 3-D speckle tracking system, which shows circumferential and longitudinal LV dyssynchrony and residual endocardial contractility, may thus have clinical significance for CRT patients.</p

Utility of tPA administration in acute treatment of internal carotid artery occlusions

Background: Intravenous tissue plasminogen activator (IV-tPA) remains part of the guidelines for acute ischemic stroke treatment, yet internal carotid artery occlusions (ICAO) are known to be poorly responsive to IV-tPA. It is unknown whether bridging thrombolysis (BT) is beneficial in such cases. Purpose: We sought to evaluate whether the use of IV-tPA improved overall clinical outcomes in patients undergoing endovascular thrombectomy (EVT) for ICA occlusions. Methods: Data from 1367 consecutive stroke cases treated with EVT from 2012-2019 were prospectively collected from a single center. Univariate and multivariate logistic regression were used to assess the relationship between IV-tPA administration and clinical outcome. Results: 153 patients were found to have carotid terminus and tandem ICAO who received EVT and presented within 4.5h of last seen well. 50% (n = 82) received IV tPA. There were no differences between the groups with respect to age, NIHSS, time to EVT and ASPECTS score. 53% had tandem ICA-MCA occlusions. Rate of recanalization (≥ TICI 2B) and sICH did not significantly differ between the two groups. Regression analysis demonstrated no effect of IV-tPA on modified Rankin Score (mRS) at 90 days and overall mortality. Factors significantly associated with reduced mortality included lower age, lower NIHSS, and better rate of recanalization. Conclusions: There was no significant difference in clinical outcomes in those receiving BT vs. direct EVT for ICAO. For centers with optimal door-to-puncture times, bypassing IV-tPA may expedite recanalization times and potentially yield more favorable outcomes. Patients with higher NIHSS and tandem lesions may have better outcomes with BT

A Prospective Comparison of Informant-based and Performance-based Dementia Screening Tools to Predict In-Hospital Delirium

Dementia is an important risk factor for delirium, but the optimal strategy for incorporating cognitive impairment into delirium risk assessment at the time of hospital admission is unknown. We compared 2 informant-based screening tools for dementia and mild cognitive impairment [AD8 and D=(MC)] to the Mini Mental State Examination (MMSE) and Mini-cog in predicting hospital-acquired delirium. This prospective cohort study at an academic medical center consisted of 162 medical inpatients over age 50 years without delirium upon admission. Each participant was evaluated using the MMSE, Mini-cog, AD8, and D=(MC) upon admission and was assessed daily for delirium. An MMSE≤24 carried a 5.5 [95% confidence intervals (CI), 2.7-11.1] relative risk for delirium, whereas cognitive impairment detected by the Mini-cog, D=(MC), or AD8 carried a 2-fold risk. Adding the D=(MC) to the MMSE increased the sensitivity for predicting delirium from 52% (range, 32% to 73%) for the MMSE alone to 65% (range, 46% to 85%) if either test was positive. If both were positive, specificity was maximized at 97% (range, 94% to 100%), but sensitivity was 17% (range, 2% to 33%). The MMSE and Mini-cog identify a large proportion of patients at risk for hospital-acquired delirium, but the combination of performance-based and an informant-based screens may maximize specificity and sensitivity

Fear of negative evaluation is associated with delusional ideation in non-clinical population and patients with schizophrenia

Purpose: A number of recent studies suggest that delusions may be explained as a continuum from normal beliefs. Fear of negative evaluation from others (FNE) is one of potential factors that might describe this psychological process of delusions. Methods: In order to examine whether FNE is associated with delusional ideation in both non-clinical population and patients with schizophrenia, two sets of data [from a non-clinical student sample (n = 282) and from patients with schizophrenia (n = 117)] were collected to examine whether Brief Fear of Negative Evaluation Scale (BFNE) score and the 21-item Peters Delusions Inventory (PDI-21) score were associated with each other. Linear regression analyses were carried out to assess if the BFNE score still remained associated with the PDI-21 scores once the confounding effects of depression were controlled. RESULTS: BFNE scores were significantly related to PDI-21 scores in both non-clinical [Pearson product-moment correlation coefficient (r) = 0.37, 95% confidence Interval (CI) = 0.25-0.48] and patient (r = 0.33, 95% CI = 0.14-0.49) samples. These associations were still significant when confounding effects of depression were controlled. Standardised coefficients for the BFNE scores in the linear regression model were 0.21 in the student sample and 0.19 in the clinical sample. Conclusions: FNE was associated with delusional ideation both in non-clinical population and in patients with schizophrenia. FNE might be a potential target for both pharmacological and psychological interventions for patients with delusions

Acute Effects of Adaptive Servo-Ventilation Therapy on Left Ventricular Regional Myocardial Function in Chronic Heart Failure Patients.

info:eu-repo/semantics/nonPublishe

Abstract Number ‐ 42: Patterns of Alert and Management of Cerebral Aneurysms using an Incidental Aneurysm Alert System (IAAS)

Introduction Incidentally discovered cerebral aneurysms have become an increasingly more common finding as patients undergo more frequent surveillance imaging. To aid in clinical management of these critical findings, we sought to develop an automated alert system for these vascular lesions. Here we describe the effectiveness of the alert system and subsequent management of incidentally discovered cerebral aneurysms on MR or CT angiography using an Incidental Aneurysm Alert System (IAAS). Methods IAAS received neuroradiology reports of MRA and CTA generated by the UCLA Department of Radiology via an HL7 feed. Reports were parsed using natural language processing to identify mentions of ‘aneurysm’. Each identification automatically generated an alert email to the interventional neuroradiology division for physician triage. Indication for imaging, specialty of ordering physician, aneurysm location and size, aneurysm development risk factors, PHASES score, patient ethnic background and subsequent management of vascular lesion were assessed. Results A total of 129 consecutive reports were reviewed from March‐December of 2020. Ten duplicate patients were excluded. Of the unique reports, 5 alerted for non‐vascular lesions and 7 did not demonstrate an aneurysm after additional imaging, resulting in a 90% detection accuracy of suspected cerebral aneurysms for a total of 107 unique cases included in the analysis. The median age was 65 years and 65% were female. Self‐identified race was 54% non‐Hispanic White, 20% other, 8% Asian, 6% Black, and 6% unknown/declined to answer. One quarter (25%) were of Hispanic ethnicity. The most common indication for imaging was acute stroke (27%). Of the detected aneurysms, 48% resulted in consultation with a neuro‐interventionalist. Of the referrals generated, 75% originated from a hospital facility and 25% from community practice. The most common referring specialty was Neurology (37%). Of those referred, just over 50% subsequently underwent diagnostic and/or therapeutic angiography. Seventy three percent of patients who underwent cerebral angiography were intervened upon either immediately or within 2 years from discovery. Eight percent of detected aneurysms were ruptured on presentation. Aneurysms were treated with flow diversion (37%), primary coiling (37%), clipping (16%) and vessel sacrifice/surgical trapping (10%). The mean PHASES score of all patients referred was 4.5, conferring a 5‐year rupture risk of ∼0.9‐1.3%. Asian and Hispanic populations had higher mean PHASES scores on presentation of 7.2 (∼2.4% 5‐year rupture risk) and 5.2 (∼1.3% 5‐year rupture risk) respectively, compared with Non‐Hispanic Caucasians of 4.1 (∼0.9% 5‐year rupture risk). For Hispanics, mean age was 54 years and mean aneurysm size 9.5 mm as compared to 65 years and 5.7 mm in non‐Hispanic Caucasians on presentation. There were no significant differences in aneurysm risk factors including HTN, smoking, fibromuscular dysplasia or family history of cerebral aneurysms. Conclusions IAAS is an effective method of alerting neuro‐interventionalists of incidentally identified cerebral aneurysms. Of those detected in our pilot series, Hispanics were younger with larger aneurysms on detection. IAAS may have potential value in connecting general physicians with cerebrovascular specialists, improving the management of patients with incidentally discovered cerebral aneurysms