Prolongation of the QTc Interval Is Seen Uniformly During Early Transmural Ischemia

ObjectivesIn order to more clearly understand the electrocardiographic manifestations of early transmural ischemia, we studied electrocardiograms (ECGs) in patients undergoing balloon angioplasty.BackgroundDecisions regarding reperfusion strategies in patients with acute myocardial infarction rely largely on the presence of ST-segment elevation (STE) in the ECG, consequently with significant limitations. Studies of the “ischemic cascade” show that ST-segment changes occur well after the onset of wall motion abnormalities.MethodsWe prospectively analyzed ECGs obtained at 20-s intervals in 74 patients undergoing elective balloon angioplasty. The ECGs were analyzed using 3 methodologies. In 74 patients, the ST-segment, the T-wave, and the QT-interval were analyzed using the MUSE (General Electric HC, Menomonee Falls, Wisconsin) automated system (MUSE). Fifty patients were also analyzed using the Interval Editor automated system (IE; General Electric HC). In 20 patients, measurements were made manually.ResultsTransmural ischemia prolonged the QTc interval (using the Bazett’s formula) in 100% of patients. In all 74 patients analyzed with MUSE, QTc interval prolonged from 423 ± 25 ms to 455 ± 34 ms (p < 0.001). In the 50 patients analyzed with IE, QTc interval prolonged in 50 of 50 (100%) patients (from 424 ± 27 ms to 458 ± 33 ms [p < 0.001]). Mean time to maximal QTc interval prolongation, changes in T-wave polarity, ≥1 mm STE, and ST-segment depression (STD) were 22, 24, 29, and 35 s, respectively. Although QTc interval prolonged in 100% of patients, T-wave changes, STE, and STD (≥1 mm) occurred in 7%, 15%, and 7%, respectively.ConclusionsThe QTc interval prolongs in 100% of patients with early transmural ischemia. When compared with clinically accepted indexes of transmural ischemia (i.e., STD and STE [≥1 mm]) it is the earliest ECG abnormality

Low admission LDL-cholesterol is associated with increased 3-year all-cause mortality in patients with non ST segment elevation myocardial infarction

Background: The relationship between admission low-density lipoprotein (LDL) levels and long-term outcomes has not been established in patients with acute coronary syndrome. We tested the hypothesis that patients who develop non-ST segment elevation myocardial infarction (NSTEMI) despite low LDL have a worse cardiovascular outcome in the long term. Methods: Patients admitted with NSTEMI between 1 January 1997 and 31 December 2000 and with fasting lipid profiles measured within 24 hours of admission were selected for analysis. Baseline characteristics and 3-year all-cause mortality were compared between the patients with LDL above and below the median. Multivariate analysis was used to determine the predictors of all-cause mortality, and adjusted survival was analyzed using the Cox proportional hazard model. Results: Of the total of 517 patients, 264 had LDL &#163; 105 mg/dL and 253 had LDL > 105 mg/dL. There was no difference in age, gender, severity of coronary artery disease, and left ventricular ejection fraction between the 2 groups. Thirty-six percent of patients with LDL &#163; 105 mg/dL and 24% of patients with LDL > 105 mg/dL were on lipid-lowering therapy on admission. After 3 years, patients with admission LDL &#163; 105 mg/dL had higher all-cause mortality rate compared to patients with LDL > 105 mg/dL (14.8% vs. 7.1%, p = 0.005). The higher all-cause mortality persisted (OR 1.8, 95% CI 1.0&#8211;3.5, p = 0.05) even after adjustment for confounding variables. Conclusions: In our cohort, lower LDL-cholesterol at admission was associated with decreased 3-year survival in patients with NSTEMI. Whether this was a result of current therapy or a marker for worse baseline characteristics needs to be studied further

Low admission triglyceride and mortality in acute coronary syndrome patients

Background: The relationship between admission triglyceride (TG) levels and long-term outcomes has not been established in patients with acute coronary syndrome. We tested the hypothesis that patients who develop non-ST segment elevation myocardial infarction (NSTEMI) despite low TG have a worse cardiovascular outcome in the long term. Methods: Patients admitted with NSTEMI between 1 January 1997 and 31 December 2000 and with fasting lipid profiles measured within 24 hours of admission were included for analysis. Baseline characteristics and three-year all-cause mortality were compared between the patients with TG above and below the median. Multivariate analysis was used to determine the predictors of all-cause mortality and adjusted survival was analyzed using the Cox proportional hazard model. Results: Of 517 patients, 395 had TG &#163; 200 mg/dL and 124 had TG > 200 mg/dL. Patients with low TG were more often Caucasian, with no significant differences in gender or severity of coronary artery disease between the two groups. There was a trend for increased all-cause mortality at six months (9% vs 3%, p = 0.045) and three years (13.4% vs 5.6%, p = 0.016) in patients with low TG. In multivariate analysis, low TG level at admission was an independent predictor of increased mortality at three years (adjusted OR 2.5, 95% CI = 1.04&#8211;5.9, p = 0.04). Conclusions: In our cohort, lower TG at admission is associated with increased three-year mortality in patients with NSTEMI. Whether this is a result of current therapy, or a marker for worse baseline characteristics, needs to be studied further. (Cardiol J 2011; 18, 3: 297&#8211;303

Oral potentially malignant disorders: Risk of progression to malignancy

© 2017 Elsevier Inc. Oral potentially malignant disorders (OPMDs) have a statistically increased risk of progressing to cancer, but the risk varies according to a range of patient- or lesion-related factors. It is difficult to predict the risk of progression in any individual patient, and the clinician must make a judgment based on assessment of each case. The most commonly encountered OPMD is leukoplakia, but others, including lichen planus, oral submucous fibrosis, and erythroplakia, may also be seen. Factors associated with an increased risk of malignant transformation include sex; site and type of lesion; habits, such as smoking and alcohol consumption; and the presence of epithelial dysplasia on histologic examination. In this review, we attempt to identify important risk factors and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient