Myocardial stress perfusion scintigraphy for outcome prediction in patients with severe left ventricular systolic dysfunction

Abstract: Coronary angiography has been recommended in all patients with suspected chronic coronary syndrome and left ventricular ejection fraction (LVEF) ≤35%. The role of ischemia testing, for example, through stress-rest myocardial perfusion scintigraphy (MPS), for risk prediction is not well established. Methods: We evaluated 1576 consecutive patients referred to MPS and stratified into 3 LV ejection fraction (LVEF) categories: ≤35%, 36–49%, and ≥ 50%. Results: Patients with LVEF ≤35% were oldest, most often men, and with the highest likelihood of prior early (elective or urgent) coronary revascularization. They had also the highest values or summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS), as well as the highest frequency of significant coronary artery disease, and a greater number of diseased vessels. Follow-up: In this subgroup, 32 cardiovascular death or non-fatal myocardial infarction (MI) (21%), 35 all-cause deaths (22%), and 37 cardiovascular deaths, non-fatal MI, or late revascularizations (27%) were recorded with the shortest survival among all LVEF classes. SRS, SSS, and SDS had very low area under the curve values for the prediction of the 3 endpoints, with very high cut-offs, respectively. SRS and SSS cut-offs predicted a worse outcome in Cox regression models including the number of diseased vessels and early revascularization. Conclusions: In patients with LVEF ≤35%, SRS and SSS are less predictive of outcome than in patients with better preserved systolic dysfunction, but their cut-offs retain independent prognostic significance from the number of vessels with significant stenoses and from early revascularization

Food-Based dietary guidelines around the World: Eastern Mediterranean and Middle Eastern Countries

In Eastern Mediterranean countries, undernutrition and micronutrient deficiencies coexist with overnutrition-related diseases, such as obesity, heart disease, diabetes and cancer. Many Mediterranean countries have produced Food-Based Dietary Guidelines (FBDGs) to provide the general population with indications for healthy nutrition and lifestyles. This narrative review analyses Eastern Mediterranean countries' FBDGs and discusses their pictorial representations, food groupings and associated messages on healthy eating and behaviours. In 2012, both the WHO and the Arab Center for Nutrition developed specific dietary guidelines for Arab countries. In addition, seven countries, representing 29% of the Eastern Mediterranean Region population, designated their national FBDGs. At the moment several of these guidelines are available only in the English language. In summary, Eastern Mediterranean FBDGs mainly focus on food safety, not all are available in the local Arabic language, and they do not provide specific suggestions for the large number of foreign workers and migrants

Nutritional Screening and Anthropometry in Patients Admitted From the Emergency Department

Background: Due to the high prevalence of malnutrition among hospitalized patients, screening and assessment of nutritional status should be routinely performed upon hospital admission. The main objective of this observational study was to evaluate the prevalence of and the risk for malnutrition, as identified by using three nutritional screening tests, and to observe whether some anthropometric and functional parameters used for nutritional evaluation were related to these test scores. Methods: This single-center observational study included 207 patients admitted from the emergency department for hospitalization in either the internal medicine or surgery units of our institution from September 2017 to December 2018. The prevalence of malnutrition among this patient sample was evaluated by using the Nutritional Risk Screening (NRS-2002), the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body mass index (BMI), bioimpedance analysis (BIA), handgrip strength (HGS) and calf circumference (CC) assessments were also performed. Results: According to the NRS-2002, 93% of the patients were at no risk or at low nutritional risk (NRS score < 3), and 7% were at a high nutritional risk (NRS score ≥ 3). On the other hand, according to the SGA, 46.3% of the patients were well-nourished (SGA-a), 49.8% were moderately malnourished (SGA-b), and 3.9% were severely malnourished (SGA-c). Finally, according to the GLIM criteria, 18% patients were malnourished. Body weight, body mass index (BMI), phase angle (PhA), CC and HGS were significantly lower in the patients with NRS scores ≥ 3, SGA-c and in patients with stage 1 and stage 2 malnutrition, according to the GLIM criteria. Conclusion: The NRS-2002, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status. In particular, the lowest NRS-2002, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status

Breast cancer survivors : analysis of rest-activity circadian rhythm

Rest-activity rhythm (RAR) indicates the activity levels during the 24 hours and it is a marker of the circadian timing system (CTS). In detail, RAR disruption has been found in breast cancer (BC) at different stages of clinical pathway (Berger et al., 2012). To date, there are no studies that analyze RAR in breast cancer survivors several years after the diagnosis. Aim of the current study is to analyze RAR, by actigraphy, in a population of BC survivors 5 years after the primary diagnosis, and to compare their RAR characteristics with healthy controls. A total of 28 women were recruited for the study: 15 were BC survivors at 5 years from the primary diagnosis (BC-group) and 13 were controls (Ctrl-group), matched for age, sex and BMI. All participants were requested to undergo clinical visit to obtain: height and body mass to calculate BMI, systolic and diastolic blood pressure, heart rate, glycemia, total cholesterol, high density lipoproteins, low density lipoproteins and triglycerides. In addition, all participants were monitored for a continuous 7-day actigraphic monitoring to evaluate RAR. Anthropometric, cardiovascular and blood chemistry characteristics were homogeneous in BC-group and Ctrl-group: no significant differences were observed between the two groups for all the parameters. The single cosinor method revealed statistically significant RAR (p&lt;0.001) in all the participants. The population mean cosinor showed a significant RAR in both groups (p&lt;0.001). A significant difference in RAR between BC-group and Ctrl-group was demonstrated by the Hotelling T2 test. Specifically, MESOR (192.0 vs 276.4 a.c. in BC-group and Ctrl-group, respectively; p&lt;.001) and Amplitude (167.0 vs 222.6 a.c. in BC-group and Ctrl-group, respectively; p&lt;.001) resulted significantly lower in BC-group compared to Ctrl-group. Breast cancer survivors, at 5 years after diagnosis, showed lower activity levels compared to healthy controls