Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions

Background: Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue. Objective: We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT. Methods: Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined. Results: Eighty-three patients (mean age, 61.5 ± 12.5 years; n = 67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53-0.77), 100% (95% CI, 0.76-1.00), 100% (95% CI, 0.90-1.00), and 41% (95% CI, 0.26-0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51-0.64), 100% (95% CI, 0.99-1.00), 99% (95% CI, 0.94-1.00), and 92% (95% CI, 0.90-0.93), respectively, to detect myocardial hypoenhancement. Conclusions: Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions. © 2010 Society of Cardiovascular Computed Tomography.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Renes, Paola. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Diez, Eduardo. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Pereyra, Jorge. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Gomez, Estela. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: De Lillo, Gustavo. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rodriguez, Alfredo E.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: McFadden, Eugene P.. Cork University Hospital; Irland

Probing atmospheric electric fields in thunderstorms through radio emission from cosmic-ray-induced air showers

We present measurements of radio emission from cosmic ray air showers that took place during thunderstorms. The intensity and polarization patterns of these air showers are radically different from those measured during fair-weather conditions. With the use of a simple two-layer model for the atmospheric electric field, these patterns can be well reproduced by state-of-the-art simulation codes. This in turn provides a novel way to study atmospheric electric fields

Microbial life in the deep terrestrial subsurface

The distribution and function of microorganisms is a vital issue in microbial ecology. The US Department of Energy`s Program, ``Microbiology of the Deep Subsurface,`` concentrates on establishing fundamental scientific information about organisms at depth, and the use of these organisms for remediation of contaminants in deep vadose zone and groundwater environments. This investigation effectively extends the Biosphere hundreds of meters into the Geosphere and has implications to a variety of subsurface activities

Rationale and design of a prospective substudy of clinical endpoint adjudication processes within an investigator-reported randomised controlled trial in patients with coronary artery disease: the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY)

pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias. Methods and analysis We designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months followed by aspirin monotherapy for the primary efficacy endpoint of death, nonfatal myocardial infarction, non-fatal stroke or urgent target vessel revascularisation and superior for the primary safety endpoint of type 3 or 5 bleeding according to the Bleeding Academic Research Consortium criteria. This study will comprehensively assess the comparative safety and efficacy of the two tested antithrombotic strategies on CEC-adjudicated ischaemic and bleeding endpoints and will provide insights into the role of a standardised CEC adjudication process on the interpretation of study findings by quantifying the level of concordance between IR-reported and CEC-adjudicated events. Ethics and dissemination GLASSY has been approved by local ethics committee of all study sites and/or by the central ethics committee for the country depending on country-specific regulations. In all cases, they deemed that it was not neces

Everolimus-eluting stents and paclitaxel-eluting stents in patients presenting with myocardial infarction: Insights from the two-year results of the COMPARE prospective randomised controlled trial

Aims: Although large clinical trials have shown that everolimus-eluting stents (EES) significantly reduce target vessel revascularisation (TVR), myocardial infarction (MI) and stent thrombosis (ST) compared to paclitaxel-eluting stents (PES) in diverse populations, there is a paucity of data comparing EES and PES in patients presenting with MI. Methods and results: We performed a post hoc subgroup analysis on COMPARE, an all-comer trial comparing EES to PES. We identified 863 patients (EES=434, PES=429 treated for MI: 452 ST-elevation MI (STEMI) and 411 non ST-elevation MI (NSTEMI). EES was associated with a significant reduction in the primary endpoint, a composite of all-cause mortality, MI, and TVR, at two years (RR=0.57; 95% CI: 0.40-0.83, p=0.002). While the effect was more marked in the STEMI (RR=0.51; 95% CI: 0.30-0.87, p=0.01) than the NSTEMI subgroup (RR=0.65; 95% CI: 0.39-1.08, p=0.09),

The spectrum of liver disease in the acquired immunodeficiency syndrome

Abnormal liver chemistries, unexplained fevers, or hepatomegaly prompted 36 liver biopsies on 34 patients with the acquired immunodeficiency syndrome. The most common finding was the presence of hepatic granulomas, seen in 13 of the biopsy specimens. Eight of these granulomas were ill-defined, and 5 were more clearly associated with mycobacterial disease. Portal fibrosis and fatty infiltration were common, but a paucity of significant inflammatory activity was seen despite elevated aspartate aminotransferase levels, perhaps related to the underlying immunoincompetent status. Other noteworthy histopathologic findings included 1 patient each with peliosis hepatis and cryptococcal hepatitis. Electron-microscopic evidence of cytoplasmic tubular structures or viral particles were seen within the hepatocytes of 2 patients. It is concluded that a broad spectrum of hepatic histopathology may be seen in the acquired immunodeficiency syndrome, and that liver biopsy may be diagnostically valuable in the clinical investigation of such patients

Can private, non-university-affiliated cardiothoracic training programs provide sufficient surgical experience in cardiac tumors?

Surgical case volumes in non-university-affiliated cardiothoracic surgery training programs in the US have been extensively studied by the Residency Review Committee (RRC) for thoracic surgery. The RRC has established that these programs offer a broad experience in common cardiothoracic procedures such as myocardial revascularization, valvular surgery, and cardiopulmonary transplantation. However, resident exposure to other important but less common cardiac surgical conditions in these programs remains unanswered. To address this question, an institutional review board-approved retrospective review of the experience of thoracic surgery residents with one of the rarest of surgical conditions, cardiac tumors, was conducted at the Ochsner Clinic Foundation in New Orleans, Louisiana. A survey of existing private, non-university-affiliated US cardiothoracic surgery training programs was conducted to determine the extent of the cardiac tumor experience in these programs. The results were then compared with selected university programs