Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart: relevance to athletic screening.

The present study compared the ECG abnormalities associated with the LV remodeling of HCM (nondilated, hypertrophic LV) and that of athlete's heart (augmented LV mass due to increase of both cavity dimension and wall thickness), with particular reference to the prevalence, clinical significance, and relevance to screening of the ECG pattern of isolated increase of QRS voltages. The main study objective was to evaluate the risk to miss a diagnosis of HCM by interpreting as normal the ECG pattern of isolated increase of QRS amplitude in highly trained athletes

Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients

View at Publisher|Ask by NILDE(opens in a new window)| Export | Download | Add to List | More... Journal of Thoracic Oncology Volume 9, Issue 3, March 2014, Pages 390-396 Does surgery improve survival of patients with malignant pleural mesothelioma?: A multicenter retrospective analysis of 1365 consecutive patients (Article) Bovolato, P.a, Casadio, C.b, Bill\ue8, A.c , Ardissone, F.d, Santambrogio, L.e, Ratto, G.B.f, Garofalo, G.c, Bedini, A.V.g, Garassino, M.c, Porcu, L.h, Torri, V.h, Pastorino, U.d a Department of Thoracic Surgery, Ospedale Civili Brescia, Brescia, Italy b Department of Thoracic Surgery, Ospedale Maggiore Novara, Novara, Italy c Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy View additional affiliations View references (32) Abstract BACKGROUND: Surgery with pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) can be an option for selected patients with resectable malignant pleural mesothelioma (MPM). The aim of this study was to investigate the impact of surgical treatment on the outcome of patients with MPM. METHODS: We retrospectively reviewed data from 1365 consecutive patients with histologically proven MPM, treated from 1982 to 2012 in six Institutions. Patients received chemotherapy alone (n = 172), best supportive care (n = 690), or surgical treatment (n = 503), by either P/D (n = 202) or EPP (n = 301) with or without chemotherapy. RESULTS: After a median follow-up of 6.7 years (range, 1.1-14.8), 230 patients (16.8%) were alive; median survival for patients who received palliative treatment or chemotherapy alone, P/D, and EPP were 11.7 (95% CI, 10.5-12.5), 20.5 (95% CI, 18.2-23.1), and 18.8 (95% CI, 17.2-20.9) months, respectively. The 30-day mortality was 2.6% after P/D and 4.1% after EPP (p = 0.401). According to multivariate analysis (n = 1227), age less than 70, epithelial histology, and chemotherapy were independent favorable prognostic factors. In the subset of 313 patients (25.5%) with all favorable prognostic factors, median survival was 18.6 months after medical therapy alone, 24.6 months after P/D, and 20.9 months after EPP (p = 0.596). CONCLUSIONS: Our data suggest that patients with good prognostic factors had a similar survival whether they received medical therapy only, P/D, or EPP. The modest benefit observed after surgery during medical treatment requires further investigation, and a large multicenter, randomized trial, testing P/D after induction chemotherapy versus chemotherapy alone in MPM patients with good prognostic factors, is needed

Marginal Overlap between Electrocardiographic Abnormalities in patients with Hypertrophic Cardiomyopathy and Trained Athletes: Implications for Preparticipation Screening.

Background: Hypertrophic cardiomyopathy (HCM) is usually associated with ECG abnormalities such as left ventricular hypertrophy (LVH), repolarization changes, and pathologic Q waves; instead, physiologic hypertrophy in trained athletes manifests as an isolated increase of QRS amplitude. We assessed whether the ECG pattern of pathologic hypertrophy of HCM overlaps with that of physiologic hypertrophy of athlete\u2019s heart, particularly by evaluating what proportion of individuals from both groups had pure QRS voltage criteria (Sokolow-Lyon) for LVH. Methods: Using accepted diagnostic criteria, we examined and compared the ECG tracings of 260 consecutive patients with clinical and echocardiographic diagnosis of HCM and those of 1005 trained athletes undergoing preparticipation cardiovascular evaluation, including ECG and echocardiography. Results: An abnormal ECG was found in 246 of 260 (94.6%) patients with HCM and in 817 of 1005 athletes (81.3%). The majority of patients with HCM had one or more of the following ECG changes: repolarization ST/T abnormalities in 209 (80%), pathologic Q waves (Q waves 650.04 s in duration or 6525% of the height of the ensuing R wave) in 103 (39.6%); left atrial enlargement in 75 (28.8%), intraventricular conduction abnormalities (QRS duration 6590 ms) in 71 (27.3%) and left axis deviation in 9 (3.5%). ECG tracings showed isolated increase of QRS voltages in 5 HCM patients (1.9%) and were completely normal in 14 (5.4%). Compared with patients with HCM, trained athletes significantly more often had isolated voltage criteria for LVH (403, 40%; p<0.0001), but less often showed negative T waves (27, 2.7%; p<0.0001), pathologic Q waves (17, 1.7%; p<0.0001), and nonvoltage criteria of LVH (13, 1.3%; p<0.0001). No athletes with isolated voltage criteria had echocardiographic evidence of HCM. Conclusions: ECG in HCM overlaps marginally with ECG findings in trained athletes. An isolated increase of QRS voltage is an unusual pattern (1.9%) of LVH in patients with HCM, while is frequently observed in trained athletes. Systematic echocardiographic evaluation of athletes fulfilling isolated QRS voltage criteria at preparticipation screening is not justified, resulting in a considerable cost savings