Atorvastatin increases exercise leg blood flow in healthy adults

Objectives

We sought to examine the effect of atorvastatin therapy on exercise leg blood flow in healthy middle-aged and older-men and women.

Background

The vasodilatory response to exercise decreases in humans with aging and disease and this reduction may contribute to reduced exercise capacity.

Methods

We used a double-blind, randomly assigned, placebo-controlled protocol to assess the effect of atorvastatin treatment on exercising leg hemodynamics. We measured femoral artery blood flow (FBF) using Doppler ultrasound and calculated femoral vascular conductance (FVC) from brachial mean arterial pressure (MAP) before and during single knee-extensor exercise in healthy adults (ages 40–71) before (PRE) and after (POST) 6 months of 80 mg atorvastatin (A: 14 men, 16 women) or placebo (P: 14 men, 22 women) treatment. FBF and FVC were normalized to exercise power output and estimated quadriceps muscle mass.

Results

Atorvastatin reduced LDL cholesterol by approximately 50%, but not in the placebo group (p < 0.01). Atorvastatin also increased exercise FBF from 44.2 ± 19.0 to 51.4 ± 22.0 mL/min/W/kg muscle whereas FBF in the placebo group was unchanged (40.1 ± 16.0 vs. 39.5 ± 16.1) (p < 0.01). FVC also increased with atorvastatin from 0.5 ± 0.2 to 0.6 ± 0.2 mL/min/mmHg/W/kg muscle, but not in the placebo subjects (P: 0.4 ± 0.2 vs. 0.4 ± 0.2) (p < 0.01).

Conclusions

High-dose atorvastatin augments exercising leg hyperemia. Statins may mitigate reductions in the exercise vasodilatory response in humans that are associated with aging and disease.     

Impact of reflux esophagitis on the esophageal function before and after laparoscopic fundoplication

Background

High-resolution manometry (HRM), which is breakthrough testing equipment to evaluate esophageal motor function, was developed in Europe and United State and has garnered attention. Moreover, multichannel intraluminal impedance pH (MII-pH) testing has allowed us to grasp all liquid/gas reflux including not only acid but also non-acid reflux. We examined the impact of the presence of reflux esophagitis (RE) on esophageal motor function before and after laparoscopic fundoplication.

Materials and methods

The subjects included 100 patients (male: 63 patients, mean age: 54.1?±?15.8) among 145 patients who underwent laparoscopic fundoplication for GERD associated diseases during a 4-year period from October 2012 to September 2016, excluding 6 patients who underwent further surgery, 32 patients on whom HRM was not performed, 3 patients who had technical errors during testing, and 4 patients for whom the status of RE was unknown. Regarding HRM, Mano Scan from Given Imaging Ltd. was used, and for the analysis, Mano View version 3.0 from the same company was used, after which data was calculated based on the Chicago Classification advocated by Pandolfino et al. Moreover, for the MII-pH testing, Sleuth manufactured by Sandhill Scientific. Inc. was used and automatic analysis was conducted by a computer. Postoperative assessments were conducted 3 months following surgery for all. Data was described in the median value and inter-quartile range, with a statistically significant difference defined as p?<?0.05 by Chi square, Mann–Whitney, and Wilcoxon tests.

Results

RE+?group (Los Angeles classification A:B:C:D?=?7:9:16:12 patients) included 44 patients (44%), of older age compared to the RE? group (62 vs. 50 years, p?=?0.012) and a higher Body Mass Index value (24.0 vs. 22.5, p?=?0.045); however, no differences were observed in terms of gender and duration of symptoms. In the preoperative findings on MII-pH, the RE+?group demonstrated significantly longer acid reflux time (4.7 vs. 1.3%, p?=?0.005), while in the HRM findings, the RE? group demonstrated a significantly longer abdominal esophagus (0 vs. 0.4 cm, p?=?0.049) and maintained esophageal body motor function (DCI: 1054 vs. 1407 mmHg s cm, p?=?0.021, Intact peristalsis ratio: 90 vs. 100%, p?=?0.037). As to the comparison of the treatment effect before and after laparoscopic fundoplication (Toupet fundoplication for all), significant improvements were observed in both groups in various parameters regarding reflux including acid reflux time, total number of liquid reflux episodes and total number of reflux episodes. Moreover, for both groups, the total length of the lower esophageal sphincter (LES) (RE+?group: 2.7 vs. 3.2 cm, p?=?0.001, RE? group: 3.0 vs. 3.4 cm, p?=?0.003) and the total length of the abdominal esophagus (RE+?group: 0 vs. 1.6 cm, p?<?0.001, RE? group: 0 vs. 1.8 cm, p?=?0.001) were significantly extended following surgery; however, no change was observed in DCI before and after surgery.

Conclusions

Regardless of the presence of RE, cardiac function and LES function were improved following laparoscopic Toupet fundoplication, but no changes were observed in esophageal body motor function.

     

The decline in skeletal muscle mass with aging is mainly attributed to a reduction in type II muscle fiber size

Background

The loss of skeletal muscle mass with aging has been attributed to a decline in muscle fiber number and muscle fiber size.

Objective

To define to what extent differences in leg muscle cross-sectional area (CSA) between young and elderly men are attributed to differences in muscle fiber size.

Methods

Quadriceps muscle CSA and type I and type II muscle fiber size were measured in healthy young (n = 25; 23 ± 1y) and older (n = 26; 71 ± 1y) men. Subsequently, the older subjects performed 6 months of resistance type exercise training, after which measurements were repeated. Differences in quadriceps muscle CSA were compared with differences in type I and type II muscle fiber size.

Results

Quadriceps CSA was substantially smaller in older versus young men (68 ± 2 vs 80 ± 2 cm², respectively; P < 0.001). Type II muscle fiber size was substantially smaller in the elderly vs the young (29%; P < 0.001), with a tendency of smaller type I muscle fibers (P = 0.052). Differences in type II muscle fiber size fully explained differences in quadriceps CSA between groups. Prolonged resistance type exercise training in the elderly increased type II muscle fiber size by 24 ± 8% (P < 0.01), explaining 100 ± 3% of the increase in quadriceps muscle CSA (from 68 ± 2 to 74 ± 2 cm²).

Conclusion

Reduced muscle mass with aging is mainly attributed to smaller type II muscle fiber size and, as such, is unlikely accompanied by substantial muscle fiber loss. In line, the increase in muscle mass following prolonged resistance type exercise training can be attributed entirely to specific type II muscle fiber hypertrophy.     

Sex Differences in the Management and 5-Year Outcome of Young Patients (<55 Years) with Acute Coronary Syndromes

Background

Young women are usually protected against coronary artery disease due to hormonal and risk-factor profile. Previous studies have suggested poorer outcome in women hospitalized with acute coronary syndrome as compared with men. However, when adjusted for age and other risk factors, this difference does not remain significant. We compared the risk profile and outcome between young (≤55 years) women and men admitted with acute coronary syndrome.

Resistance training reduces susceptibility to eccentric exercise-induced muscle dysfunction in older women

This study evaluated the effect of age on susceptibility to muscular weakness and damage caused by eccentric (ECC) exercise and determined whether this susceptibility was altered by resistance training. Young and older women performed concentric (CON) and ECC one repetition maximum (1 RM) strength tests of the quadriceps femoris. Older women also performed knee extension training for 12 weeks. An unaccustomed bout of ECC knee extension exercise was performed before and after training, and CON and ECC 1 RM were reassessed for 11 days after the ECC bout. Magnetic resonance imaging was used to evaluate changes in muscle water content associated with muscle damage. Before training, older subjects showed a larger decline in CON (p =.008) and ECC (p =.03) strength induced by the unaccustomed ECC bout, compared with the young subjects. One day following the ECC bout, the older women showed a 24% reduction in CON and a 27% reduction in ECC 1 RM, compared with only 6% (CON) and 10% (ECC) in the younger women. A magnetic resonance imaging evaluation indicated that edema or damage was significantly greater in the older untrained women than it was in young women (p <.05), but the resistance-trained older women showed no greater muscle injury than the young women (p >.05). Resistance-trained older women showed no greater decline than sedentary young women in either CON (p >.05) or ECC (p >.05) strength. In conclusion, sedentary older women are more susceptible to ECC-induced muscle dysfunction, but resistance training reduces this susceptibility.     

Muscle strength,functional performance,and self‐reported outcomes four years after arthroscopic partial meniscectomy in middle‐aged patients

Objective

To examine thigh muscle strength, functional performance, and self‐reported outcome in patients with nontraumatic meniscus tears 4 years after operation, and to study the impact of a strength deficit on self‐reported outcome and evaluate the feasibility of 3 performance tests in this patient group.

Methods

The study group comprised 45 patients (36% women, mean age 46.7) who had an arthroscopic partial meniscectomy a mean of 4 years (range 1–6 years) previously. Main outcome measures included isokinetic strength of knee extensors and flexors, functional performance (1‐leg hop, 1‐leg rising, and square‐hop tests), and a self‐reported questionnaire (Knee Injury and Osteoarthritis Outcome Score).

Results

We found lower knee extensor strength and worse 1‐leg rising capacity in the operated leg, but no difference between operated and nonoperated leg for knee flexors (P ≤ 0.004 and P > 0.3, respectively). Patients with a stronger quadriceps of the operated leg compared with the nonoperated leg had less pain and better function and quality of life (r = 0.4–0.6, P ≤ 0.010). We found the 1‐leg rising and 1‐leg hop tests to be suitable performance tests in middle‐aged meniscectomy patients.

Conclusion

Quadriceps strength is reduced in the meniscectomized leg compared with the nonoperated leg 4 years after surgery. This relative quadriceps weakness significantly affects objective and self‐reported knee function, pain, and quality of life, indicating the importance of restoring muscle function after meniscectomy in middle‐aged patients.

     

Muscle strength, mass, and quality in older men and women with knee osteoarthritis

Objective

To examine the relationship between knee osteoarthritis (OA) and muscle parameters in a biracial cohort of older adults.

Methods

Participants in the Health, Aging and Body Composition Study (n = 858) were included in this cross‐sectional analysis. Computed tomography was used to measure muscle area, and quadriceps strength was measured isokinetically. Muscle quality (specific torque) was defined as strength per unit of muscle area for both the entire thigh and quadriceps. Knee OA was assessed based on radiographic features and knee pain. We compared muscle parameters between those with and without radiographic knee OA (+RKOA group and ?RKOA group, respectively) and among 4 groups defined by +RKOA and ?RKOA with and without pain.

Results

The mean ± SD age was 73.5 ± 2.9 years and the mean ± SD body mass index (BMI) was 27.9 ± 4.8 kg/m². Fifty‐eight percent of participants were women and 44% were African American. Compared to the ?RKOA participants, +RKOA participants had a higher BMI (30.2 versus 26.8 kg/m²), larger thigh muscles (117.9 versus 108.9 cm²), and a greater amount of intermuscular fat (12.5 versus 9.9 cm²; all P < 0.0001). In adjusted models, the +RKOA participants had significantly lower specific torque (P < 0.001), indicating poorer muscle quality, than ?RKOA participants, but there was no difference between groups in quadriceps specific torque. The +RKOA without pain (P < 0.05) and the +RKOA with pain (P < 0.001) participants had lower specific torque compared to the ?RKOA without pain group. There were no significant differences in quadriceps specific torque among groups.

Conclusion

Muscle quality was significantly poorer in participants with RKOA regardless of pain status. Future studies should address how lifestyle interventions might affect muscle quality and progression of knee OA.

     

Effects of strength training and detraining on muscle quality: age and gender comparisons

Maximal force production per unit of muscle mass (muscle quality, or MQ) has been used to describe the relative contribution of non-muscle-mass components to the changes in strength with age and strength training (ST). To compare the influence of age and gender on MQ response to ST and detraining, 11 young men (20-30 years), nine young women (20-30 years), 11 older men (65-75 years), and 11 older women (65-75 years), were assessed for quadriceps MQ at baseline, after 9 weeks of ST, and after 31 weeks of detraining. MQ was calculated by dividing quadriceps one repetition maximum (IRM) strength by quadriceps muscle volume determined by magnetic resonance imaging. All groups demonstrated significant increases in IRM strength and muscle volume after training (all p < .05). All groups also increased their MQ with training (all p < .01), but the gain in MQ was significantly greater in young women than in the other three groups (p < .05). After 31 weeks of detraining, MQ values remained significantly elevated above baseline levels in all groups (p < .05), except the older women. These results indicate that factors other than muscle mass contribute to strength gains with ST in young and older men and women, but those other factors may account for a higher portion of the strength gains in young women. These factors continue to maintain strength levels above baseline for up to 31 weeks after cessation of training in young men and women, and in older men.     

Effect of baseline quadriceps activation on changes in quadriceps strength after exercise therapy in subjects with knee osteoarthritis

Objective

To examine whether pretreatment magnitude of quadriceps activation (QA) helps predict changes in quadriceps strength after exercise therapy in subjects with knee osteoarthritis (OA). We hypothesized that subjects with lower magnitudes of QA (greater failure of muscle activation) would have smaller gains in strength compared with those with higher magnitudes of QA following exercise therapy.

Methods

One hundred eleven subjects with knee OA (70 women) participated. Baseline measures included demographic information, quadriceps muscle strength, and QA using a burst‐superimposition isometric torque test. Following baseline testing, subjects underwent a 6‐week supervised exercise program designed to improve strength, range of motion, balance and agility, and physical function. On completion of the program, quadriceps strength and QA were reassessed. Multiple regression analysis was used to determine whether baseline QA predicted quadriceps strength scores at the 2‐month followup.

Results

Bivariate correlations demonstrated that baseline QA was significantly associated with quadriceps strength at baseline (ρ = 0.30, P < 0.01) and 2‐month followup (ρ = 0.23, P = 0.01). Greater magnitude of baseline QA correlated with higher strength. While controlling for baseline quadriceps strength and type of exercise therapy, the level of QA did not predict quadriceps strength at the 2‐month followup (β = ?0.04, P = 0.18).

Conclusion

Baseline QA did not predict changes in quadriceps strength following exercise therapy. Measurement of QA using the central activation ratio method does not appear to be helpful in identifying subjects with knee OA who will have difficulty improving quadriceps strength with exercise therapy.

     

Elevated natriuretic peptide levels and cognitive function in community-dwelling older adults

Background

Natriuretic peptides have prognostic value across a wide spectrum of cardiovascular diseases and may predict cognitive dysfunction in patients with cardiovascular disease, even in the absence of previous stroke. Little is known about the association of natriuretic peptides with cognitive function in community-dwelling adults. We assessed the association between N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cognitive function in community-dwelling ambulatory older adults in the Rancho Bernardo Study.

Methods

We studied 950 men and women, aged 60 years and older, who attended a research clinic visit where a medical history and examination were performed, and blood for cardiovascular disease risk factors and NT-proBNP levels were obtained. Three cognitive function tests were administered: the Mini Mental State Examination (MMSE), Trail-Making Test B (Trails B), and Category Fluency.

Results

Participants with high NT-proBNP levels (≥450 pg/mL; n = 198) were older and had a higher prevalence of coronary heart disease (12% vs 30%), and stroke (5% vs 11%; P ≤ .001 for both). In unadjusted analyses, all 3 cognitive function test scores were significantly associated with NT-proBNP levels (P < .001). After adjusting for age, sex, education, hypertension, body mass index, exercise, alcohol use, smoking, low density lipoprotein cholesterol, creatinine clearance, and previous cardiovascular disease, elevated NT-proBNP levels remained independently associated with poor cognitive performance on MMSE (odds ratio [OR] 2.0; 95% confidence interval [CI], 1.1-3.6; P = .02) and Trails B (OR 1.7; 95% CI, 1.2-2.7; P = .01), but not Category Fluency (OR 1.4; 95% CI, 0.9-2.2; P = .19). Results were unchanged after excluding the 6% of participants with a history of stroke.

Conclusions

NT-proBNP levels were strongly and independently associated with poor cognitive function in community-dwelling older adults.     

Skeletal Muscle Function and Its Relation to Exercise Tolerance in Chronic Heart Failure

Objectives. This study sought to define the relation between muscle function and bulk in chronic heart failure (HF) and to explore the association between muscle function and bulk and exercise capacity.Background. Skeletal muscle abnormalities have been postulated as determinants of exercise capacity in chronic HF. Previously, muscle function in chronic HF has been evaluated in relatively small numbers of patients and with variable results, with little account being taken of the effects of muscle wasting.Methods. One hundred male patients with chronic HF and 31 healthy male control subjects were studied. They were matched for age (59.0 ± 1.0 vs. 58.7 ± 1.7 years [mean ± SEM]) and body mass index (26.6 ± 0.4 vs. 26.3 ± 0.7 kg/m²). We assessed maximal treadmill oxygen consumption (

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₂), quadriceps maximal isometric strength, fatigue (20-min protocol, expressed in baseline maximal strength) and computed tomographic cross-sectional area (CSA) at midthigh.Results. Peak

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₂ was lower in patients (18.0 ± 0.6 vs. 33.3 ± 1.4 ml/min per kg, p < 0.0001), although both groups achieved a similar respiratory exchange ratio at peak exercise (1.15 ± 0.01 vs. 1.19 ± 0.03, p = 0.13). Quadriceps (582 vs. 652 cm², p < 0.05) and total leg muscle CSA (1,153 vs. 1,304 cm², p < 0.005) were lower in patients with chronic HF. Patients were weaker than control subjects (357 ± 12 vs. 434 ± 18 N, p < 0.005) and also exhibited greater fatigue at 20 min (79.1% vs. 92.1% of baseline value, p < 0.0001). After correcting strength for quadriceps CSA, significant differences persisted (5.9 ± 0.2 vs. 7.0 ± 0.3 N/cm², p < 0.005), indicating reduced strength per unit muscle. In patients, but not control subjects, muscle CSA significantly correlated with peak absolute

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₂ (R = 0.66, p < 0.0001) and is an independent predictor of peak absolute

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₂.Conclusions. Patients with chronic HF have reduced quadriceps maximal isometric strength. This weakness occurs as a result of both quantitative and qualitative abnormalities of the muscle. With increasing exercise limitation there is increasing muscle weakness. This progressive weakness occurs predominantly as a result of loss of quadriceps bulk. In patients, this muscular atrophy becomes a major determinant of exercise capacity.     

Do young patients have different clinical presentation of colorectal cancer causing delay in diagnosis?

Purpose

The incidence of colorectal cancer is increasing among young patients. In these patients, colorectal cancer is believed to have a poorer prognosis because it is more aggressive and diagnosed at later stages; however, the behavior of these tumors in young patients remains to be elucidated. We investigated the impact of time interval between onset of symptoms and diagnosis (TISD) at the pathologic stage of colorectal cancer in young patients.

Methods

The medical records of 215 patients with colorectal adenocarcinoma were reviewed. Patients were divided into two groups according to age. The young group (age?<?50 years) consisted of 66 patients, and the older group (age?≥?50 years) of 149 patients. Clinical variables, TISD, pathologic stage, operative mortality, and oncologic outcomes were compared between groups.

Results

The older group had less abdominal pain (74.0 vs. 56.0 %, p?=?0.0129). In multivariate analysis, the following variables were independently associated with tumor pathologic stage: personal history of inflammatory bowel disease (p?<?0.0001), family history of familial adenomatous polyposis (p?=?0.00100), and smoking (p?=?0.0070). Both groups had similar rates regarding pathologic stage (I, 15 vs. 22 %; II, 22 vs. 24 %; III, 27 vs. 16 %; IV, 37 vs. 38 %, p?=?0.3380). There was no difference in overall survival [45 (69 %) vs. 84 (61 %), p?=?0.2482] and cancer-free survival [36 (63 %) vs. 83 (62 %), p?=?0.9218] between groups.

Conclusions

Young patients with colorectal cancer had clinical and pathological presentation similar to that of older patients.     

Sex‐based differences in bleeding and long‐term adverse events after percutaneous coronary intervention in older patients with coronary artery disease

Objectives

Differences in outcomes for women and men after percutaneous coronary intervention (PCI) in older patients remain controversial. Herein, we compared 2‐year outcomes by sex in Chinese older patients undergoing PCI.

Methods

A total of 4926 consecutive patients (33.6% women, age ≥60 years, mean age 67.4 ± 5.7 years) who underwent PCI at a single center in China from January 2013 to December 2013 were included in this study. The primary endpoint was 2‐year risk of bleeding according to the Bleeding Academic Research Consortium definitions. The secondary endpoints included 2‐year risk of major adverse cardiovascular and cerebrovascular events (MACCE). Hazard ratios were generated using multivariable Cox regression.

Results

Compared with men, women had significantly higher rates of in‐hospital all‐cause mortality (0.8% vs 0.2%, P = 0.001), cardiac death (0.5% vs 0.1%, P = 0.006), MACCE (2.4% vs 1.5%, P = 0.017), and bleeding (0.4% vs 0.1%, P = 0.015). At 2‐year follow up, there were no differences between men and women for all‐cause mortality (1.9% vs 1.8%, P = 0.839) and 2‐year MACCE (13.1% vs 11.8%, P = 0.216). However, women had a higher risk of 2‐year bleeding (9.2% vs 6.2%, P < 0.001), which persisted after adjusting for baseline differences and treatment characteristics (hazard ratio 1.35, 95% confidence interval 1.06‐1.71; P = 0.014).

Conclusion

We found that older women undergoing PCI were at increased risk of 2‐year bleeding compared with men. Further dedicated studies are needed to confirm these findings.

     

Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance

Background

Anterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardiomyopathy (ARVC). Whereas the 2010 European consensus recommendations for ECG interpretation in young athletes state that ATWI beyond lead V₁ warrants further investigation, the prevalence and significance of ATWI have never been reported in a large population of asymptomatic whites.

Gender Differences in Office and Ambulatory Control of Hypertension

Background

Gender differences in hypertension control have not been explored fully.

Methods

We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night).

Results

Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P < .001). Women had a lower frequency of masked hypertension (office BP < 140/90 mm Hg and ambulatory BP ≥ 130/80 mm Hg) than men (5.9% vs 7.9%, P < .001). Women had a higher frequency of isolated office hypertension (office BP ≥ 140/90 mm Hg and ambulatory BP < 130/80 mm Hg) (32.5% vs 24.2%, P < .001). Although office BP control (office BP < 140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P = .542), ambulatory BP control (ambulatory BP < 130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P < .001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged.

Conclusion

Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.     

Lower skeletal muscle nutritive blood flow in older women is related to eNOS protein content

The relationship between muscle endothelial nitric oxide synthase (eNOS) content and nutritive flow was investigated in nonobese sedentary young (27.7 +/- 2.6 years) and older (56.6 +/- 2.1 years) women matched for body composition and (2)peak. A muscle biopsy was taken and nutritive blood flow was determined under resting conditions in the vastus lateralis of the quadriceps femoris muscle group. Muscle eNOS protein content correlated with muscle nutritive blood flow (r =.66, p <.05) and body mass index (r =.74, p <.05), but it did not correlate with VO(2)peak. Muscle eNOS content was 35% lower in young than in older women (266 +/- 36 vs 407 +/- 53 pg/mg total protein; p <.05). The mean ethanol outflow-to-inflow ratio was higher (indicating lower nutritive flow) in older and young women (.666 +/-.042 and.546 +/-.043, respectively: p <.05). Resting skeletal nutritive blood flow and muscle eNOS content was lower in older than in young women. A low muscle eNOS protein content may be linked to a low muscle nutritive blood flow in healthy women.     

Sex Differences in the Management and Outcomes of Ontario Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction

Background

Sex differences in the management of acute myocardial infarction (AMI) patients with cardiogenic shock (CS) have not been well studied.

Methods

We examined mortality and revascularization rates of 9750 patients with CS between 1992 and 2008 in the Ontario Myocardial Infarction Database. Men and women were compared in the entire cohort and in subgroups divided by age (aged < 75 years vs aged ≥ 75 years) and revascularization availability at presenting hospital. Logistic regression was used to determine the adjusted effect of sex on mortality and to determine predictors of revascularization.

Results

The incidence of CS was higher in women (3.7% of female vs 2.7% of male AMI patients; P < 0.001). Women with CS were older than men (mean age: 75.5 vs 71.1 years; P < 0.001) and less likely to present to revascularization-capable sites (16% vs 19.2%; P < 0.001). Unadjusted 1-year mortality rates were higher in women (80.3% vs 75.4%; P < 0.001). Women were less likely to be revascularized (12.6% vs 17.6%; P < 0.001) and less likely to be transferred when they presented to nonrevascularization sites (11.3% vs 14.2%; P < 0.001). The strongest predictor of revascularization was presentation to a revascularization-capable site (odds ratio, 17.69; P < 0.001). After regression adjustment, there were no significant differences in mortality or revascularization between the sexes.

Conclusion

Women with CS are older than men with CS and are less likely to present to revascularization-capable sites. This accounts for the lower unadjusted revascularization rates among women compared with men. However, there are no significant sex-based differences in adjusted mortality rates.     

Excess mortality in women compared to men after PCI in STEMI: An analysis of 11,931 patients during 2000–2009

Background

Ambiguity exists whether gender affects outcome in patients undergoing percutaneous coronary intervention (PCI).

Methods

To evaluate the relationship between gender and outcome in a large cohort of PCI patients, 11,931 consecutive patients who underwent PCI for various indications during 2000–2009 were studied using survival analyses and Cox regression models.

Results

Most patients (n = 8588; 72%) were men. Women were older and more often had a history of hypertension and diabetes mellitus. Men smoked more frequently, had a more extensive cardiovascular history (previous MI, PCI and CABG), a higher prevalence of renal impairment and multi-vessel disease. In STEMI patients, women had higher 31-day mortality rates than men (11.6% vs. 6.5%, respectively, p < 0.001). This difference remained after adjustment for confounders (aHR at 30-days 1.54 and 95% CI 1.22–1.96). Likewise, higher mortality was observed at 1-year (15.1% vs. 9.3%) and 4-year follow-up (21.6% vs. 15.0%, aHR 1.30 and 95% CI 1.10–1.53). There were no differences in mortality between women and men in NSTE-ACS (aHR at 4-years 1.05 and 95% CI 0.85–1.28) or stable angina (HR at 4-years 0.85 and 95% CI 0.68–1.08).

Conclusion

Women undergoing PCI for STEMI had higher mortality than men. The excess mortality in women appeared in the first month after PCI and could only partially be explained by a difference in baseline characteristics. No gender differences in outcome in patients undergoing PCI for NSTE-ACS and stable angina were observed.     

The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases

Background

Preoperative skeletal muscle depletion or sarcopenia has been suggested to predict worse outcome after resection of colorectal liver metastases. The aim of the present study was to investigate the impact of neoadjuvant chemotherapy on preoperative skeletal muscle mass prior to liver resection.

Accessory pathway ablation in children: indications and results

Introduction

Radiofrequency ablation of accessory pathways (AP) has become a first-line treatment, except in young children where the indications are discussed because of radiation risks and complications of catheterization. The purpose of the study was to evaluate the indications and results of radiofrequency AP ablation in children and teenagers.

Methods

Electrophysiological study (EPS) was performed in 145 patients aged from 5 to 18 years (13.5 ± 3) with a preexcitation syndrome (PS).

Results

AP ablation was indicated in 66 children (group 1); others represent the group I. Group I was older and less frequently asymptomatic. All children with a spontaneous malignant form had an ablation. Group 1 has a faster conduction through the AP than group 2. The induction of reentrant tachycardia (RT), atrial fibrillation and the presence of a malignant form is more common in group 1. Failures or reappearances of WPW after ablation were frequent (20, 26%) related to a younger age (15 ± 3 vs 17 ± 4) (< 0.05). In group 2, one 18-year-old teenager with untreated RT died before ablation. Asymptomatic children are well with disappearance of PS in two. Medically treated symptomatic children are well.

Conclusion

If spontaneous malignant forms, symptoms with drugs or practice of competitive sport are indications of AP ablation, it is recommended to wait for adolescence in other children.