Prevalence and Prognostic Influence of Peripheral Arterial Disease in Patients ≥40 Years Old Admitted into Hospital Following an Acute Coronary Event

AbstractObjectiveA significant proportion of patients with ischemic heart disease have associated peripheral arterial disease (PAD), but many are asymptomatic and this condition remains underdiagnosed. We aimed to study the prevalence of PAD in patients with an acute coronary syndrome (ACS) and to evaluate its influence in hospital clinical outcomes.MethodsThe PAMISCA register is a prospective, multicenter study involving patients ≥40 years old with ACS admitted to selected Spanish hospitals. All patients had their ankle-brachial index (ABI) measured between days 3 and 7 after the ischemic event.Results1410 ACS patients (71.4% male) were included. PAD determined by ABI was documented in 561 patients (39.8%). Factors independently related to PAD were age (OR: 1.04; 95% CI: 1.03–1.06; p<0.001), smoking (OR: 1.88; 95% CI: 1.41–2.49; p<0.0001), diabetes (OR: 1.30; 95% CI: 1.02–1.65; p<0.05), previous cardiac disease (OR: 1.54; 95% CI: 1.22–1.95; p<0.001) and previous cerebrovascular disease (OR: 1.90; 95% CI: 1.28–2.80; p<0.001). Following the ACS, an ABI≤0.90 was associated with increased cardiovascular mortality (OR: 5.45; 95% CI: 1.16–25.59; p<0.05) and a higher risk of cardiovascular complications.ConclusionThe prevalence of PAD in patients ≥40 years presenting with ACS is high and it is associated with increased cardiovascular risk

Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

Quantitative Electrocardiographic Analysis in Relation to Renal Function in a Geriatric Population

Abstract Background: There is a frequent association between renal insufficiency and patients with cardiovascular disease, suggesting a common pathogenic mechanism. The electrocardiogram (ECG) is a quick and cheap tool that can detect early cardiac abnormalities. The aim of this study was to quantitatively analyze ECG alterations in relation to renal function of a population of 65 years or older. Methods: A population sample of 1,536 patients aged 65 or older (45.4% male; mean age 75.6±6.0 years) from the judicial district of Toledo, Spain, who had undergone a general medical checkup including an ECG were included. In 996 patients (64.8%) renal function (plasma creatinine and estimated glomerular filtration rate) was assessed and the relationship between ECG alterations and renal function was subsequently evaluated. Results: Only 36% of the ECGs analyzed were considered normal. Significant correlations of heart rate, QRS complex duration, and the frontal plane QRS-T angle with reduced renal function were observed. Other ECG parameters such as voltage, QRS and T wave axes, and QTc interval showed no correlation with renal function. Conclusions: In patients aged 65 years or older with impaired renal function there was a relationship of renal function with certain ECG parameters, which may constitute early markers of renal and cardiac pathology and suggest a common pathogenic mechanism

Tumor Necrosis Factorâ α and Porphyromonas gingivalis Lipopolysaccharides Decrease Periostin in Human Periodontal Ligament Fibroblasts

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141843/1/jper0694.pd

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature.The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, beta-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections.The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%).Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity.Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported