Monitoring the ageing of the cardiovascular system

This research developed a way of measuring blood flow through the capillaries and thereby monitoring the health of the endothelium, the inner lining of the blood vessels

966-45 QT Dispersion in Essential Hypertension

Increased QT dispersion (QTd) reflects regional variation in ventricular repolarisation, and has been shown in heart failure and hypertrophic cardiomyopathy to relate to an increased incidence of sudden death. As essential hypertensives (EH) are also at increased risk of sudden death we aimed to determine whether increased QTd is found in those EH who are known to be at the highest risk of sudden death. In 50 EH we measured QTd (maximum corrected QT interval minus minimum corrected QT interval), echocardiographic left ventricular mass index (LVMI) (n=46 as 4 patients non-echogenic), office systolic and diastolic blood pressure (SSP, DSP), and 24 hour ambulatory systolic and diastolic blood pressure (24 SSP, 24 DSP) (n=40). Univariate analysis demonstrated no relationship between QTd and age, sex, height, weight, 24 SSP or 24 DBP. Significant relationships existed between QTd and LVMI (R2=0.25, P<0.001), SSP (R2=0.16, P<0.01), DSP (R2=0.08, P<0.05). Multiple linear regression analysis revealed the only relationships to QTd were LVMI (p<0.01) and SSP (p<0.05). Excluding 4 patients with electro-cardiographic left ventricular hypertrophy (ECG-LVH) from the analysis a significant relationship between QTd and LVMI (R2=0.13, P<0.05) and SSP (R2=0.10, P<0.05) persists. These demonstrate that increased QTd is found in EH with the highest risk of sudden death (greatest SSP and LVMI). This relationship persists in the absence of ECG-LVH. Further study of QTd, as a predictor of sudden death in EH is warranted

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar