Echocardiographic assessment at rest and during stress in patients with intermittent claudication

Objective. Skeletal muscle perfusion during walking relies on complex interactions between cardiac activity and vascular control mechanisms, why cardiac dysfunction may contribute to intermittent claudication (IC) symptoms. The study aims were to describe cardiac function at rest and during stress in consecutive IC patients, to explore the relations between cardiac function parameters and treadmill performance, and to test the hypothesis that clinically silent myocardial ischemia during stress may contribute to IC limb symptomatology. Design. Patients with mild to severe IC (n?=?111, mean age 67 y, 52% females, mean treadmill distance 195 m) underwent standard echocardiography, dobutamine stress echocardiography (SE) and treadmill testing. The patient cohort was separated in two groups based on treadmill performance (HIGH and LOW performance). Results. Ten patients (9%) had regional wall motion abnormalities of which three had left ventricular ejection fraction <50% at standard echocardiography. A majority had lower than expected systolic- and diastolic ventricular volumes. LOW performers had smaller diastolic left ventricular volumes and lower global peak systolic velocity during dobutamine stress. No patient demonstrated significant cardiac dysfunction during dobutamine provocation that was not also evident at standard echocardiography. Conclusions. Most IC patients were without signs of ischemic heart disease or cardiac failure. The majority had small left ventricular volumes. The hypothesis that clinically silent myocardial ischemia impairing left ventricular function during stress may contribute to IC limb symptomatology was not supported.

Trial registration: ClinicalTrials.gov identifier: NCT01219842.     

Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort

Astrom AN, Ekback G, Ordell S, Unell L. Socio‐behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort. Community Dent Oral Epidemiol 2011; 39: 300–310. © 2010 John Wiley & Sons A/S Abstract – Objectives: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life‐course stage at which they would be expected to operate, this study assessed the impacts of socio‐behavioral and disease‐related factors on tooth loss between ages 50 and 65. Methods: In 1992, all 50‐year‐olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8888 subjects, 6346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4143 (65%) completed postal follow‐ups at ages 55, 60 and 65. Results: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50–85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life‐stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle‐age and early‐old‐age life stage). Conclusion: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease‐related factors and socio‐behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life‐course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early‐older age.     

Influence of smoking on the outcome of periodontal surgery

Abstract. The 5-year outcome following periodontal surgery was evaluated in 57 patients that had received regular maintenance care throughout the follow-up period. The study population included 20 smokers, 20 former smokers and 17 non-smokers in the age range 37–77 years. The clinical characteristics evaluated were supragingival plaque, gingival bleeding and pocket probing depth. The region assigned for surgery was, in addition, radiographically evaluated in terms of periodontal bone height. Furthermore, the occurrence of the periopathogens Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) and the gingival crevicular fluid (GCF) levels of tumor necrosis factor alpha (TNF-α) were assessed at follow-up. Plaque index was 28.5% at baseline and 32.9% at follow-up, indicating a good standard of oral hygiene, and gingival bleeding 31.7% and 24.9%, respectively, suggesting a low to moderate level of gingival inflammation. In regions assigned for surgery, pocket probing depth decreased significantly from on average 5.6 mm to 4.3 mm ( p <0.0001) and periodontal bone height increased significantly from on average 62.5% to 67.5% ( p <0.0001). In terms of bone height, the outcome was less favorable among smokers compared with non-smokers. There was a predominance of smokers among patients exhibiting loss of bone height after the 5 years of maintenance. No significant associations were found between the therapeutical outcome and supragingival plaque or subgingival occurrence of periopathogens. The associations between GCF levels of TNF-α and probing depth and bone height were unclear, whereas the level of TNF-α was significantly elevated in smokers.