Usefulness of stress gated technetium-99m single photon emission computed tomographic myocardial perfusion imaging for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction and suspected coronary artery disease

Although stress gated technetium-99m single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) is useful in differentiating ischemic from nonischemic cardiomyopathy, its prognostic usefulness in this patient population is not well understood. Consecutive unique patients with suspected coronary artery disease who, for clinical indications, underwent technetium-99m rest and stress MPI demonstrating ejection fractions ≤40% by gated SPECT imaging were retrospectively identified. In addition to prescan variables, previously defined cutoffs for gated SPECT parameters using visual and standard 17-segment semiquantitative scoring were applied and related to the occurrence of cardiac death up to 5 years after MPI. Of the 475 patients fulfilling criteria for study inclusion, follow-up was complete in 444 (93%) over 3.7 ± 1.6 years. Of 393 patients without subsequent early (≤60 days) coronary revascularization, cardiac death occurred in 64 (16%). The summed stress score, an MPI measure of the extent and severity of coronary artery disease that also accounts for the ischemic burden, was the gated SPECT parameter most related to cardiac death with Kaplan-Meier 5-year cardiac death-free survival of 85.6% and 67.3% in patients with summed stress scores ≤8 and >8, respectively (p <0.001). In multivariate Cox regression analysis, a summed stress score >8 independently contributed to cardiac death (adjusted hazard ratio 2.20, 95% confidence interval 1.34 to 3.61), and its addition to the model significantly increased the global chi-square value over prescan variables (from 32.46 to 41.67, p = 0.002). In conclusion, stress MPI data from gated technetium-99m SPECT scans are useful for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction in whom there is suspicion of underlying coronary artery disease.     

Inflammatory markers and plaque morphology: an optical coherence tomography study

Background

OCT with its unique image resolution is the ideal method to detect culprit lesion characteristics in different clinical presentations. The identification of inflammatory markers related to plaque characteristics may be of clinical importance.

Methods

Thirty-two patients with acute coronary syndromes (ACS) and fourteen patients with stable angina pectoris (SAP) were enrolled in this study. Culprit lesion morphology was assessed by optical coherence tomography (OCT) in patients with ACS and SAP. The possible relations between serum levels of high sensitivity-C reactive protein (hs-CRP) and interleukin-18 (IL-18) with plaque characteristics were investigated in those patients.

Results

Plaque rupture and thin-cap fibroatheroma (TCFA) were detected more frequently in ACS patients compared with SAP patients, (78.6% vs. 14.3%, p < 0.001, 92.9% vs. 14.3%, p < 0.001, respectively). Higher levels of serum hs-CRP and IL-18 were found in patients with plaque rupture vs. those with no plaque rupture (median value: 19.2 mg/L vs. 1.6 mg/L, p < 0.001 and 219.5 pg/ml vs. 127.5 pg/ml, p = 0.001 respectively), and TCFA vs. those without TCFA (median value: 15.2 mg/L vs. 1.6 mg/L, p = 0.004 and 209.0 pg/ml vs.153.2 pg/ml, p = 0.03 respectively). Serum hs-CRP was the only independent predictor of plaque rupture (p = 0.02, odds ratio 1.1, 95% confidence interval 1.0 to 1.2). A cut-off value of hs-CRP > 4.5 mg/L could detect ruptured plaque with a sensitivity of 91.7% and a specificity of 77.8%.

Conclusions

OCT detected plaque rupture and TCFA more frequent in ACS patients compared with SAP. Elevated hs-CRP and IL-18 were positively related to plaque instability and rupture.     

Post‒cataract surgery endophthalmitis outbreak caused by multidrug-resistant Pseudomonas aeruginosa

In June 2010, a severe outbreak of 13 cases of post-cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection.     

Phenotype and genotype frequency of β-thalassemia and sickle cell disease carriers in Halkidiki, Northern Greece

A decade of screening (years 2000 to 2010) for hemoglobinopathies in 3,931 patients was performed at the General Hospital of Poligiros, Halkidiki, Northern Greece. Among the patients examined, 10.8% heterozygotes for β-thalassemia (β-thal) were found, as well as 4.1% with sickle cell disease and 1.2% with double β-thal/Hb S [β6(A3)Glu→Val] heterozygosity. Iron deficiency was observed in 23.4%. The geographical distribution in the region revealed a substantial incidence of hemoglobinopathies even in mountainous areas. This pattern did not follow the typical distribution according to the malaria hypothesis, as incidence did not dovetail with swamp locations recorded in the past. The HBB gene mutations for 85 patients were also analyzed. Most prevalent in Halkidiki, Northern Greece, was the codon 39 (C>T) mutation (27.1%) followed by the IVS-I-110 (G>A) mutation (22.4%); this was in direct contrast to the current distribution of the same mutations seen in the rest of Greece (Greek National Genetic Database, GNGD). This frequency inversion was statistically significant, with the difference from the GNGD being 20.6% for the IVS-I-110 mutation (p <0.0005) and 7.6% for the codon 39 mutation (p = 0.0238). The history of Halkidiki, denoting a clear example of geographical isolation from the rest of the country, may possibly account for a potentially diverse genetical identity of the disease in this region.     

Incidence,aetiology, treatment outcome and complications of maxillofacial fractures. A retrospective study from Northern Greece

AimTo analyse the pattern of maxillofacial injuries and treatment outcomes in Northern Greece.MethodsA tertiary referral single centre hospital; retrospective chart review. Demographics, aetiology, fixation technique (Rigid Internal Fixation: RIF; Maxillomandibular Fixation: MMF) post-surgical infections, aesthetics and occlusion were recorded.ResultsOne thousand and ten males and 229 females were operated between 1998 and 2008. Mean age was 29.6 ± 13. Mean number of plates per patient was 3.96 ± 2.28. For those with midfacial fractures (n = 379) mean was 4.02 ± 2.05. For those with mandibular fractures (n = 333), mean was 2.74 ± 0.94 while those with combined mandible and midface fractures (n = 216) were treated using 5.74 ± 2.87 plates per patient. Among those treated with plates, an unadjusted 22% increased risk for post-surgical infection per plate used (OR = 1.22, 95%CI: 1.13–1.32) was found. Patients with mandibular fractures were more satisfied with their post-surgical facial appearance in contrast to those with midfacial or combined midfacial and mandibular fractures. Female patients were less satisfied with their post-surgical facial appearance than males.DiscussionThis study verified a young males predominance, a shift towards more assault related fractures –especially in females– and similar post-surgical results for MMF and RIF modalities in mandibular fractures. In those patients treated with RIF, placement of fewest plates possible to obtain stability better serves aesthetics at the same time reducing risk for post-surgical infections and malocclusion.