scholarly journals Echocardiographic screening for the anomalous aortic origin of coronary arteries

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001495
Author(s):  
Francesco Bianco ◽  
Massimo Colaneri ◽  
Valentina Bucciarelli ◽  
Francesca Chiara Surace ◽  
Federica Valentina Iezzi ◽  
...  
Keyword(s):  
Young Adults ◽  
Coronary Arteries ◽  
Sports Activity ◽  
Coronary Ct ◽  
Registration Number ◽  
Echocardiographic Assessment ◽  
Echocardiographic Images ◽  
Double Blinded ◽  
Significant Increment

AimsWe sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.MethodsIn 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.ResultsA total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).ConclusionsThe application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.Trial registration numberNCT04224090.

scholarly journals 1163 Diagnostic performance of a new echocardiographic method for coronary arteries abnormalities assessment

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Bianco ◽  
M Colaneri ◽  
V Bucciarelli ◽  
F C Surace ◽  
F V Iezzi ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Retrospective Diagnosis ◽  
Coronary Ct ◽  
Chamber View ◽  
Echocardiographic Evaluation ◽  
Echocardiographic Assessment ◽  
Left And Right ◽  
Echocardiographic Images ◽  
Double Blinded ◽  
Anomalous Coronary

Abstract Background The echocardiographic assessment of coronary arteries abnormalities (CCA) has always been challenging. In this view, we aimed to assess the performance of a new echocardiographic-based diagnostic method for CAA in pediatric and young adults’ population. Methods over 5 years, we examined all the outpatients undergoing routine echocardiography in our department. Our method consisted of 4-focused specific view scan: parasternal short-axis, parasternal long-axis, both left and right outflow tract, and apical 5-chamber view. Coronary-CT confirmed the CAA diagnosis. Two independent physicians retrospective reviewed the echocardiographic images, in a double-blinded fashion (coronary-CT and diagnosis), for performance analysis. Results in 2014-18, 5,998 outpatients underwent echocardiography (median age 14 years [6, 21 - IQR]). A total of 27 CAA were diagnosed: overall prevalence 0.0045%, 0.022% of incidence. N = 17/27 were anomalous aortic origin of coronary arteries (AAOCA), N = 3/27 anomalous coronary arteries from the pulmonary artery (ACAPA), and 7/27 fistulas. After the implementation, we found a progressive increment of CAA diagnosis (P for Trend = 0.038), in particular of AAOCA: both left and right coronaries (P-trend = 0.021 and P = trend 0.010, respectively). Our method showed better sensitivity than traditional CAA echocardiographic evaluation: 85% vs 55%, P = 0.032 [AUC 0.77, 95% CI (0.68, 0.87) and AUC 0.92, 95% CI (0.85, 0.99), respectively], with a good interobserver agreement for the adjudicated double-blinded retrospective diagnosis (99.75%, K = 0.73, P &lt; 0.001). Conclusions the application of a new echocardiographic-based method for CAA-detection led to a significantly increased rate of identified anomalies. This approach demonstrated better sensitivity than traditional echocardiographic assessment. Implementing this protocol in clinical practice may improve the CAA diagnosis, and probably reduce the occurrence of CAA-related sudden cardiac death.

scholarly journals Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018391 ◽  
Author(s):  
Nivethitha Ilangkovan ◽  
Christian Backer Mogensen ◽  
Hans Mickley ◽  
Annmarie Touborg Lassen ◽  
Jess Lambrechtsen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Cardiac Events ◽  
Background Population ◽  
Significant Difference ◽  
Registration Number ◽  
Double Blinded

ObjectivesTo examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom.DesignA double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up.SettingEmergency and cardiology departments in the Region of Southern Denmark.SubjectsIn total, 229 patients with NSCP were compared with 722 patients from a background comparator population.Main outcomes measuresPrevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact.ResultsThere was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death.ConclusionThe prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.Trial registration numberNCT02422316; Pre-results.

scholarly journals A 10-year follow-up study of the cardiovascular risk factors in children aged 6–16 years

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Triantafyllidi ◽  
E Dretsiou ◽  
D Benas ◽  
P Trivilou ◽  
G Pavlidis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Arterial Hypertension ◽  
Lipid Profile ◽  
Food Habits ◽  
Aortic Stiffness ◽  
Adult Life ◽  
Endothelial Glycocalyx ◽  
Sports Activity

Abstract Background Obesity and arterial hypertension in children represent well recognized risk factors for future cardiovascular (CV) events during early adult life. We aimed to investigate any changes regarding several parameters affecting the CV status of children aged 6–16 years after a 10-year follow-up period. Methods A cohort of 143 children 6–16 years old (79/64 boys/girls, mean age 9±2 years) was evaluated regarding food habits (fish/chicken/vegetables/fruit per week), obesity (BMI), office blood pressure (SBP/DBP), aortic stiffness (PWV), lipid profile (HDL, LDL) and sports activity (hours of exercise/week). After a 10-years follow-up period, we managed to re-evaluate 62/143 (43%) young adults (33/31 boys/girls, mean age 20±2 years) for the same parameters plus endothelial function estimated by endothelial glycocalyx integrity (PBR5–25). Results We found that after 10 years, young adults compared to themselves had increased BMI, SBP/DBP and PWV (p&lt;0.001), decreased HDL and LDL (p&lt;0.001 and p=0.004, respectively), increased consumption of chicken and vegetables (p&lt;0.001 and p=0.05, respectively) and decreased consumption of fish and fruits (p=0.004 and p=0.001, respectively) per week and finally increased weekly hours of sports activity (p=0.005). Mean PBR5–25 was 1.9±0.2 μm. Regarding obesity, the majority of children were overweight (20%) or obese (41%) while the majority of young adults were normoweight (60%) and only 11% obese. Regarding arterial hypertension (mean value of a triple office BP measurement), we measured BP &gt;95th percentile in 7% of the children (50% of children had finally white coat hypertension) while just one young adult (2%) had BP &gt;140 mmHg). Conclusions After 10 years, children became young adults with an improved status regarding obesity, normal BP levels, favorable lipid profile as for LDL levels, almost healthy food habits who also spend more hours in sport activities. However, HDL was decreased, aortic stiffness was increased while there are no comparable data regarding endothelial glycocalyx integrity. Overall, the profile of young adults seems protective against future CV events. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial

2019 ◽  
Vol 78 (6) ◽  
pp. 837-843 ◽  
Author(s):  
Christelle Darrieutort-Laffite ◽  
Stephane Varin ◽  
Guillaume Coiffier ◽  
Jean-David Albert ◽  
Lucie Planche ◽  
...  
Keyword(s):  
Tendon Healing ◽  
Double Blind ◽  
Registration Number ◽  
Calcific Tendonitis ◽  
Ultrasound Guided Puncture ◽  
Double Blinded ◽  
Pain At Rest ◽  
And Function ◽  
Guided Puncture

ObjectiveSteroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL.MethodsThis was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0–100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up.ResultsThe estimated mean difference in the first week’s maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups.ConclusionNon-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption.Trial registration numberNTC02403856.

scholarly journals Chinese Herbal Medicine Dingji Fumai Decoction for Ventricular Premature Contraction: A Real-World Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bo Liang ◽  
Fei-Hu Zou ◽  
Ling Fu ◽  
Hui-Ling Liao
Keyword(s):  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Clinical Symptoms ◽  
Medication Compliance ◽  
Controlled Trial ◽  
Ventricular Premature Contraction ◽  
Traditional Chinese Medicine Syndrome ◽  
Chinese Herbal ◽  
Double Blinded

Background. Chinese herbal medicine Dingji Fumai Decoction (DFD) is widely clinically used for ventricular premature contraction (VPC). This real-word trial was designed to assess the safety and effectiveness of DFD for VPC. Methods. This was a double-blinded, randomized placebo-controlled trial. Patients with VPC were randomized (1 : 1) to treatment with DFD combined with metoprolol (DFD arm) or metoprolol combined with placebo (MET arm). A primary end point was a composite of clinical symptoms and signs determined by the traditionalChinese medicine syndrome score and the number of VPC determined by the Holter examination. Second outcomes were adverse events, medication compliance, and laboratory examination. Results. 144 patients were randomized to DFD arm (76 patients) or MET arm (68 patients), and 136 cases (71 in DFD arm and 65 in MET arm) finally completed this trial. After a 12-week follow-up, DFD arm significantly decreased traditional Chinese medicine syndrome score and the number of VPC compared with MET arm (P=0.003 and 0.034, respectively). There was no adverse drug effect and patient medication compliance was good. Conclusions. Superiority with DFD arm for VPC was demonstrated over MET arm for both the safety and effectiveness end points.

scholarly journals Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults

2016 ◽  
Vol 86 (5) ◽  
pp. 713-720 ◽  
Author(s):  
Sung-Hwan Choi ◽  
Kyung-Keun Shi ◽  
Jung-Yul Cha ◽  
Young-Chel Park ◽  
Kee-Joon Lee
Keyword(s):  
Young Adults ◽  
Treatment Modality ◽  
Orthodontic Treatment ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Initial Examination ◽  
The Stability ◽  
Maxillary Deficiency ◽  
Time Point

ABSTRACT Objective:  To evaluate the stability of nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults with a transverse maxillary deficiency. Materials and Methods:  From a total of 69 adult patients who underwent MARME followed by orthodontic treatment with a straight-wire appliance, 20 patients (mean age, 20.9 ± 2.9 years) with follow-up records (mean, 30.2 ± 13.2 months) after debonding were selected. Posteroanterior cephalometric records and dental casts were obtained at the initial examination (T0), immediately after MARME removal (T1), immediately after debonding (T2), and at posttreatment follow-up (T3). Results:  Suture separation was observed in 86.96% of subjects (60/69). An increase in the maxillary width (J-J; 1.92 mm) accounted for 43.34% of the total expansion with regard to the intermolar width (IMW) increase (4.43 mm; P &lt; .001) at T2. The amounts of J-J and IMW posttreatment changes were −0.07 mm (P &gt; .05) and −0.42 mm (P  =  .01), respectively, during retention. The postexpansion change in middle alveolus width increased with age (P &lt; .05). The postexpansion change of interpremolar width (IPMW) was positively correlated with the amount of IPMW expansion (P &lt; .05) but not with IMW. The changes of the clinical crown heights in the maxillary canines, first premolars, and first molars were not significant at each time point. Conclusions:  Nonsurgical MARME can be a clinically acceptable and stable treatment modality for young adults with a transverse maxillary deficiency.

scholarly journals Cardiovascular consequences of discontinuing low-dose rivaroxaban in people with chronic coronary or peripheral artery disease

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318758
Author(s):  
Gilles R Dagenais ◽  
Leanne Dyal ◽  
Jacqueline J Bosch ◽  
Darryl P Leong ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Low Dose ◽  
Cardiovascular Death ◽  
Stroke Rate ◽  
Early Stopping ◽  
Peripheral Artery ◽  
Once Daily ◽  
Registration Number ◽  
Artery Disease

ObjectiveIn patients with chronic coronary or peripheral artery disease enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies trial, randomised antithrombotic treatments were stopped after a median follow-up of 23 months because of benefits of the combination of rivaroxaban 2.5 mg two times per day and aspirin 100 mg once daily compared with aspirin 100 mg once daily. We assessed the effect of switching to non-study aspirin at the time of early stopping.MethodsIncident composite of myocardial infarction, stroke or cardiovascular death was estimated per 100 person-years (py) during randomised treatment (n=18 278) and after study treatment discontinuation to non-study aspirin (n=14 068).ResultsDuring randomised treatment, the combination compared with aspirin reduced the composite (2.2 vs 2.9/100 py, HR: 0.76, 95% CI 0.66 to 0.86), stroke (0.5 vs 0.8/100 py, HR: 0.58, 95% CI 0.44 to 0.76) and cardiovascular death (0.9 vs 1.2/100 py, HR: 0.78, 95% CI 0.64 to 0.96). During 1.02 years after early stopping, participants originally randomised to the combination compared with those randomised to aspirin had similar rates of the composite (2.1 vs 2.0/100 py, HR: 1.08, 95% CI 0.84 to 1.39) and cardiovascular death (1.0 vs 0.8/100 py, HR: 1.26, 95% CI 0.85 to 1.86) but higher stroke rate (0.7 vs 0.4/100 py, HR: 1.74, 95% CI 1.05 to 2.87) including a significant increase in ischaemic stroke during the first 6 months after switching to non-study aspirin.ConclusionDiscontinuing study rivaroxaban and aspirin to non-study aspirin was associated with the loss of cardiovascular benefits and a stroke excess.Trial registration numberNCT01776424.

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