178 research outputs found
Respiratory influence on left atrial volume calculation with 3D-echocardiography
BACKGROUND: Left atrial volume (LAV) estimation with 3D echocardiography has been shown to be more accurate than 2D volume calculation. However, little is known about the possible effect of respiratory movements on the accuracy of the measurement. METHODS: 100 consecutive patients admitted with chest pain were examined with 3D echocardiography and LAV was quantified during inspiratory breath hold, expiratory breath hold and during free breathing. RESULTS: Of the 100 patients, only 65 had an echocardiographic window that allowed for 3D echocardiography in the entire respiratory cycle. Mean atrial end diastolic volume was 45.4âÂąâ14.5 during inspiratory breath hold, 46.4âÂąâ14.8 during expiratory breath hold and 45.6âÂąâ14.3 during free respiration. Mean end systolic volume was 17.6âÂąâ7.8 during inspiratory breath hold, 18.8âÂąâ8.0 during expiratory breath hold and 18.3âÂąâ8.0 during free respiration. No significant differences were seen in any of the measured parameters. CONCLUSIONS: The present study adds to the feasibility of 3D LAV quantitation. LAV estimation by 3D echocardiography may be performed during either end-expiratory or end-inspiratory breath-hold without any significant difference in the calculated volume. Also, the LAV estimation may be performed during free breathing
De novo electrocardiographic abnormalities in persons living with HIV
Abstract Persons living with HIV (PLWH) may have increased incidence of cardiovascular events and longer QTc intervals than uninfected persons. We aimed to investigate the incidence and risk factors of de novo major electrocardiogram (ECG) abnormalities and QTc prolongation in well-treated PLWH. We included virologically suppressed PLWH without major ECG abnormalities, who attended the 2-year follow-up in the Copenhagen comorbidity in HIV infection (COCOMO) study. ECGs were categorized according to Minnesota Code Manual. We defined de novo major ECG abnormalities as new major Minnesota Code Manual abnormalities. Prolonged QTc was defined as QTcâ>â460Â ms in females and QTcâ>â450Â ms in males. Of 667 PLWH without major ECG abnormalities at baseline, 34 (5%) developed de novo major ECG abnormalities after a median of 2.3Â years. After adjustment, age (RR: 1.57 [1.08â2.28] per decade older), being underweight (RR: 5.79 [1.70â19.71]), current smoking (RR: 2.34 [1.06â5.16]), diabetes (RR: 3.89 [1.72â8.80]) and protease inhibitor use (RR: 2.45 [1.27â4.74) were associated with higher risk of getting de novo major ECG abnormalities. Of PLWH without prolonged QTc at baseline, only 11 (1.6%) participants developed de novo prolonged QTc. Five percent of well-treated PLWH acquired de novo major ECG abnormalities and protease inhibitor use was associated with more than twice the risk of de novo major ECG abnormalities. De novo prolonged QTc was rare and did not seem to constitute a problem in well-treated PLWH
Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain The Randomized Controlled CATCH Trial
AbstractObjectivesThe aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care.BackgroundThe prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain.MethodsPatients with acute chest pain but normal electrocardiograms and troponin values were randomized to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain.ResultsWe randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients withdrew their consent. The median (interquartile range) follow-up duration was 18.7 (range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients (11%) had a primary endpoint versus 47 patients (16%) in the standard care group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to 0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization for UAP, and late symptom-driven revascularization) was observed in 5 patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14 patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06).ConclusionsA coronary CTA-guided treatment strategy appears to improve clinical outcome in patients with recent acute-onset chest pain and normal electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000
Growth of the thoracic aorta in the smoking population: The Danish Lung Cancer Screening Trial
Background: Although the descending aortic diameter is larger in smokers, data about thoracic aortic growth is missing. Our aim is to present the distribution of thoracic aortic growth in smokers and to compare it with literature of the general population. Methods: Current and ex-smokers aged 50â70 years from the longitudinal Danish Lung Cancer Screening Trial, were included. Mean and 95th percentile of annual aortic growth of the ascending aortic (AA) and descending aortic (DA) diameters were calculated with the first and last non-contrast computed tomography scans during follow-up. Determinants of change in aortic diameter over time were investigated with linear mixed models. Results: A total of 1987 participants (56% male, mean age 57.4 Âą 4.8 years) were included. During a median follow-up of 48 months, mean AA and DA growth rates were comparable between males (AA 0.12 Âą 0.31 mm/year and DA 0.10 Âą 0.30 mm/year) and females (AA 0.11 Âą 0.29 mm/year and DA 0.13 Âą 0.27 mm/year). The 95th percentile ranged from 0.42 to 0.47 mm/year, depending on sex and location. Aortic growth was comparable between current and ex-smokers and aortic growth was not associated with pack-years. Our findings are consistent with aortic growth rates of 0.08 to 0.17 mm/years in the general population. Larger aortic growth was associated with lower age, increased height, absence of medication for hypertension or hypercholesterolemia and lower Agatston s
Rationale and Design of the First Double-Blind, Placebo-Controlled Trial with Allogeneic Adipose Tissue-Derived Stromal Cell Therapy in Patients with Ischemic Heart Failure:A Phase II Danish Multicentre Study
Background. Ischemic heart failure (IHF) has a poor prognosis in spite of optimal therapy. We have established a new allogeneic Cardiology Stem Cell Centre adipose-derived stromal cell (CSCC_ASC) product from healthy donors. It is produced without animal products, in closed bioreactor systems and cryopreserved as an off-the-shelf product ready to use. Study Design. A multicentre, double-blind, placebo-controlled phase II study with direct intramyocardial injections of allogeneic CSCC_ASC in patients with chronic IHF. A total of 81 patients will be randomised at 2â:â1 to CSCC_ASC or placebo. There is no HLA tissue type matching needed between the patients and the donors. Methods. The treatment will be delivered by direct injections into the myocardium. The primary endpoint is change in the left ventricle endsystolic volume at 6-month follow-up. Secondary endpoints are safety and changes in left ventricle ejection fraction, myocardial mass, stroke volume, and cardiac output. Other secondary endpoints are change in clinical symptoms, 6-minute walking test, and the quality of life after 6 and 12 months. Conclusion. The aim of the present study is to demonstrate safety and the regenerative efficacy of the allogeneic CSCC_ASC product from healthy donors in a double-blind, placebo-controlled, multicentre study in patients with IHF
MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction - DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy
Background
Midregional proadrenomedullin (
MR
âpro
ADM
) has demonstrated prognostic potential after myocardial infarction (
MI
). Yet, the prognostic value of
MR
âpro
ADM
at admission has not been examined in patients with STâsegmentâelevation
MI
(
STEMI
).
Methods and Results
The aim of this substudy, DANAMIâ3 (The Danish Study of Optimal Acute Treatment of Patients with
ST
âsegmentâelevation myocardial infarction), was to examine the associations of admission concentrations of
MR
âpro
ADM
with shortâ and longâterm mortality and hospital admission for heart failure in patients with
ST
âsegmentâelevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of
MR
âpro
ADM
was 0.64Â nmol/L (25thâ75th percentiles, 0.53â0.79). Within 30Â days 23 patients (2.0%) died and during a 3âyear followâup 80 (7.1%) died and 38 (3.4%) were admitted for heart failure. A doubling of
MR
âpro
ADM
was, in adjusted models, associated with an increased risk of 30âday mortality (hazard ratio, 2.67; 95% confidence interval, 1.01â7.11;
P
=0.049), longâterm mortality (hazard ratio, 3.23; 95% confidence interval, 1.97â5.29;
P
<0.0001), and heart failure (hazard ratio, 2.71; 95% confidence interval, 1.32â5.58;
P
=0.007). For 30âday and 3âyear mortality, the area under the curve for
MR
âpro
ADM
was 0.77 and 0.78, respectively. For 3âyear mortality, area under the curve (0.84) of the adjusted model marginally changed (0.85;
P
=0.02) after addition of
MR
âpro
ADM
.
Conclusions
Elevation of admission
MR
âpro
ADM
was associated with longâterm mortality and heart failure, whereas the association with shortâterm mortality was borderline significant.
MR
âpro
ADM
may be a marker of prognosis after STâsegmentâelevation myocardial infarction but does not seem to add substantial prognostic information to established clinical models.
Clinical Trial Registration
URL
:
http:/www.ClinicalTrials.gov
/. Unique identifiers:
NCT
01435408 and
NCT
01960933.
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