Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea

AbstractObjectivesThe purpose of this study was to characterize the outcome of patients referred for exercise echocardiographic evaluation of dyspnea.BackgroundLittle information exists regarding outcome of patients with dyspnea.MethodsWe identified 443 patients with unexplained dyspnea, 2,033 with chest pain, and 587 with both symptoms referred for exercise echocardiography.ResultsCompared to those with chest pain alone, patients referred for dyspnea alone were older, predominately men, and had lower workload, lower ejection fraction (EF), more prior myocardial infarction (MI), and abnormal rest electrocardiograms. Patients with both symptoms were similar to those with dyspnea, but more had prior revascularization. Exercise echocardiography showed ischemia in 42% of patients with dyspnea, 19% with chest pain, and 58% with both symptoms. During 3.1 ± 1.8 years follow-up, cardiac death (5.2% vs. 0.9%, p < 0.0001) and nonfatal MI (4.7% vs. 2.0%, p < 0.0001) occurred more often in patients with dyspnea. Events in patients with both symptoms were similar to those with dyspnea, except for revascularization (20% vs. 13%, p = 0.0004). For patients with dyspnea, independent predictors of events were previous MI (hazard ratio [HR] 3.35, p < 0.0001), male gender (HR 1.94, p = 0.0252), EF (HR 0.95/10% increment, p < 0.0001), and increase in wall motion score index with exercise (HR 4.19/0.25 U, p < 0.0001), but not chest pain.ConclusionsPatients with unexplained dyspnea have a high likelihood of ischemia and an increased incidence of cardiac events. Exercise echocardiography provides independent information for identifying patients at risk. In patients with known or suspected coronary artery disease, dyspnea is a symptom requiring investigation

A 2000-year annual record of snow accumulation rates for Law Dome, East Antarctica

Accurate high-resolution records of snow accumulation rates in Antarctica are crucial for estimating ice sheet mass balance and subsequent sea level change. Snowfall rates at Law Dome, East Antarctica, have been linked with regional atmospheric circulation to the mid-latitudes as well as regional Antarctic snowfall. Here, we extend the length of the Law Dome accumulation record from 750 years to 2035 years, using recent annual layer dating that extends to 22 BCE. Accumulation rates were calculated as the ratio of measured to modelled layer thicknesses, multiplied by the long-term mean accumulation rate. The modelled layer thicknesses were based on a power-law vertical strain rate profile fitted to observed annual layer thickness. The periods 380–442, 727–783 and 1970–2009 CE have above-average snow accumulation rates, while 663–704, 933–975 and 1429–1468 CE were below average, and decadal-scale snow accumulation anomalies were found to be relatively common (74 events in the 2035-year record). The calculated snow accumulation rates show good correlation with atmospheric reanalysis estimates, and significant spatial correlation over a wide expanse of East Antarctica, demonstrating that the Law Dome record captures larger-scale variability across a large region of East Antarctica well beyond the immediate vicinity of the Law Dome summit. Spectral analysis reveals periodicities in the snow accumulation record which may be related to El Niño–Southern Oscillation (ENSO) and Interdecadal Pacific Oscillation (IPO) frequencies

Outcome of Patients With Hypertrophic Cardiomyopathy and a Normal Electrocardiogram

ObjectivesThis study sought to clarify the frequency, clinical phenotype, and prognosis of those patients with hypertrophic cardiomyopathy (HCM) who present with a normal electrocardiogram (ECG).BackgroundHypertrophic cardiomyopathy is the most common cause of sudden death in young people. Screening advocates have recommended a 12-lead ECG for the early detection of HCM in athletes, yet the clinical outcomes of those presenting with a normal ECG remains to be fully delineated.MethodsBaseline characteristic and echocardiographic data were collected on all patients with HCM who initially presented to our institution with a diagnostic echocardiogram but a normal ECG. Follow-up was obtained and compared with the prognosis of HCM patients who presented with abnormal ECGs.ResultsWe compared 135 HCM patients with a normal ECG with 2,350 HCM patients with an abnormal ECG. The latter group was more likely to have worse symptoms, have higher gradients, and a greater degree of septal wall thickness than the patients with a normal ECG. Severe obstructive symptoms requiring surgical myectomy and implantation of an implantable cardioverter-defibrillator were more common in patients with abnormal ECGs. Cardiac survival was significantly better in the group with a normal ECG at presentation—none of these patients had a cardiac death at follow-up.ConclusionsAlmost 6% of patients presenting with demonstrable echocardiographic evidence of HCM had a normal ECG at the time of diagnosis. This subset of patients with normal ECG-HCM appears to exhibit a less severe phenotype with better cardiovascular outcomes