Sociodemographic Variations in the Uptake of Faecal Immunochemical Tests in Primary Care

Background: Faecal Immunochemical Testing (FIT) usage for symptomatic patients is increasing, but variations in use by sociodemographics are unknown. We introduced FIT for symptomatic patients in November 2017. Aim: Identify whether demographics, ethnicity or social deprivation affect FIT return in symptomatic patients. Design and Setting: FIT was introduced as a triage tool in Primary Care and was mandated for all colorectal referrals (except rectal bleeding/mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify colorectal cancer risk. Method: All referrals November 2017-December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression. Results: 35,289 patients returned their index FIT (90.7%), 3631 (9.3%) did not. On multivariate analysis, males were less likely to return FIT (OR 1.11, 95%CI 1.03-1.19). Patients over 65 were more likely to return FIT (OR 0.78 for non-return, 95%CI 0.72-0.83). Unreturned FIT was more than doubled in the most compared to the least deprived (OR 2.20, 95%CI 1.99-2.43). Patients from Asian (OR 1.82, 95%CI 1.58-2.10), Black (OR 1.21, 95%CI 0.98-1.49) and Mixed/Other ethnic groups (OR 1.29, 95%CI 1.05-1.59) were more likely to not return FIT compared to White ethnicity. 599 colorectal cancers were detected (1.5%), 561 in those who returned a first FIT request, 38 in those who did not. Conclusion: FIT return in those suspected of having colorectal cancer varies by gender, age, ethnicity, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and colorectal cancer detection should be considered as FIT usage expands

Function and mechanics of the left ventricle: from tissue Doppler imaging to three dimensional speckle tracking

One of the most common indications in echocardiography is the evaluation of left ventricular function. The traditional measurement of ejection fraction is based upon tracing the left ventricular borders and calculating left ventricular volumes using geometric assumptions. Now, with the introduction of three-dimensional echocardiography, the evaluation of left ventricular function is easier to carry out and with superior accuracy and reproducibility. However, regional myocardial function is more difficult to evaluate because it relies on visual assessment of endocardial motion and wall thickening. Currently, new techniques like tissue Doppler and speckle tracking imaging allow regional and global quantification of myocardial function through new parameters, like deformation/strain, rotation and twist. In this regard, speckletracking echocardiography (STE) has been introduced as a technique for angle-independent quantification of multidirectional myocardial strain and rotation. With the arrival of three-dimensional systems, the entire left ventricle can be evaluated with this technique, lacking the inherent weakness of two-dimensional and tissue Doppler methods. Three dimensional speckle tracking (3DST) has potential to be an ideal tool to assess not only global myocardial function but regional function through deformation, rotation, twist and untwisting parameters

Is the mitral valve area flow-dependent in mitral stenosis? A Dobutamine stress echocardiographic study

AbstractObjectivesThe purpose of this study was to compare the effect of changes in flow rate on the mitral valve area (MVA) derived from two-dimensional echocardiographic planimetry and Doppler pressure half-time (PHT) methods in patients with mitral stenosis (MS).BackgroundDobutamine stress echocardiography has been proposed as a means of assessing the severity of MS. However, data regarding the effect of an increase in flow rate on MVA are limited. If MVA is indeed flow-dependent, this has important implications for the assessment of the severity of MS, particularly in the setting of reduced cardiac output (CO).MethodsDobutamine echocardiography was performed in 57 patients with isolated MS who were in sinus rhythm. The MVA was determined by planimetry and Doppler PHT methods.ResultsCardiac output increased by ≥50% in 27 patients (group I) and by <50% in 30 patients (group II). In group I, the MVA by planimetry increased by only 10.6 ± 2% and the MVA by PHT increased by 21.9 ± 4.8%. These changes were similar to those observed in group II (10.7 ± 3% and 14.8 ± 4%, respectively; p = NS), despite a much smaller increase in CO. A clinically important change (from the severe to mild category) occurred in only one patient when using the PHT method and in none by planimetry.ConclusionsChanges in flow rate result in small but clinically insignificant changes in echocardiographic MVA measurement. These methods provide an accurate assessment of MS severity in a majority of patients, independent of changes in flow rate

Influence of donor cocaine use on outcome after cardiac transplantation: analysis of the United Network for Organ Sharing Thoracic Registry

Heart transplantation from donors with a history of cocaine abuse remains controversial. Therefore, we examined the consequence of donor cocaine-use history on all-cause mortality and the development of coronary artery disease after heart transplantation. Using the United Network for Organ Sharing Thoracic Registry we identified 9,217 first-time heart-only adult transplant recipients between January 1999 and December 2003, and then divided this cohort into sub-groups based on the reported history of donor cocaine use. Multivariate analysis revealed no difference in mortality or development of coronary artery disease at 1 and 5 years between transplant recipients who received an organ from donors with a history of cocaine use when compared with donors having no history of cocaine use

Left ventricular remodelling index (LVRI) in various pathophysiological conditions: a real‐time three‐dimensional echocardiographic study

BACKGROUND: Various studies have reported a close correlation between real‐time three‐dimensional echocardiography (RT3DE) and cine magnetic resonance imaging studies for the assessment of cardiac volumes and mass. OBJECTIVE: The aim of our study was to evaluate changes in left ventricular volumes and mass in subjects with different pathophysiological conditions. A ratio between left ventricular mass and end‐diastolic volume (LVRI), detected by RT3DE, was used to describe various patterns of left ventricular remodelling. METHODS: RT3DE was performed to calculate left ventricular end‐diastolic (LVEDV) and end‐systolic volume (LVESV), ejection fraction (LVEF) and mass in 220 selected subjects. Of these, 152 were healthy volunteers, 19 top‐level rowers, 23 patients with dilated cardiomyopathy and 26 patients with hypertrophic cardiomyopathy. Off‐line analysis was performed by two independent operators by tracing manual endocardial and epicardial borders of the left ventricle through eight cutting planes. Inter‐ and intra‐observer variability were calculated. RESULTS: Despite the increase in LV volume and mass in the rowers, LVRI remained unchanged compared with control subjects (p = 0.455), while significantly lower values were found patients with dilated cardiomyopathy (p<0.001) and significantly higher values in patients with hypertrophic cardiomyopathy (p<0.001). There was inter‐ and intra‐observer variability. CONCLUSION: The LVRI may serve as a simple and useful indicator of left ventricular adaptation to physiological and pathological conditions