The Impact of the ISCHEMIA Trial on Clinical Practice: an Interventionist’s Perspective

Cardiovascular Drugs and Therapy - The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial is the latest in a series of studies evaluating...     

Isolated costal hyperostosis: a rare cause of severe hemothorax

Chest pain due to hemothorax is rare. However, the possibility of traumatic hemothorax must always be suspected. We report a case of a 15-year-old girl with hemothorax after erosion of the intercostal artery of the left seventh rib by a histological proved solitary costal hyperostosis. She presented with a 2-month history of intermittent left-sided chest pain and 3 episodes of acute chest pain followed by dizziness and loss of consciousness. The chest radiograph revealed a large left pleural effusion and a thin-section chest computed tomography scan that was performed after drainage of the hemothorax indicated a spicule projecting inward into the chest from the left seventh rib. After thoracotomy, a solitary costal hyperostosis causing a traumatic pseudoaneurysm of the intercostal artery was removed by partial resection of the left seventh rib, the intercostals vessels were ligated, and the pseudoaneurysm excised.     

Hand orientation in hand paddle swimming

The aim of this research was to study the effect of hand paddles on the pitch, the sweepback angles and other stroke kinematic characteristics of the hand during front crawl swimming. Ten female competitive swimmers swam without and with small (116 cm (2)) and large (268 cm (2)) paddles. Four cameras (60 Hz) were used to record the underwater strokes and the digitizing was undertaken using the Ariel Performance Analysis System. When the size of the paddles increased, the stroke length, the mean swimming velocity and the total duration of the stroke were significantly increased (p < 0.05), while the average velocity of the hand during the pull and the push phases were significantly decreased (p < 0.05). The stroke rate was decreased significantly (p < 0.05) only when using large paddles. The relative duration of the separate phases of the stroke, the magnitude of the medial-lateral displacements and the pitch and sweepback angles of the hand were not modified, indicating that the use of hand paddles did not caused significant alterations in the orientation and the movement of the hand during the underwater stroke in front crawl swimming.     

CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial

ObjectivesThis study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches).BackgroundPerformance of CCTA compared with ICA has not been assessed in patients with very high burdens of stress-induced ischemia and a high likelihood of anatomically significant coronary artery disease (CAD). A blinded CCTA was performed after enrollment to exclude patients with left main (LM) disease or no obstructive CAD before randomization to an initial conservative or invasive strategy, the latter guided by ICA and optimal revascularization.MethodsRates of concordance were calculated on a per-patient basis in patients randomized to the invasive strategy. Anatomic significance was defined as ≥50% diameter stenosis (DS) for both modalities. Sensitivity analyses using a threshold of ≥70% DS for CCTA or considering only CCTA images of good-to-excellent quality were performed.ResultsIn 1,728 patients identified by CCTA as having no LM disease ≥50% and at least single-vessel CAD, ICA confirmed 97.1% without LM disease ≥50%, 92.2% with at least single-vessel CAD and no LM disease ≥50%, and only 4.9% without anatomically significant CAD. Results using a ≥70% DS threshold or only CCTA of good-to-excellent quality showed similar overall performance.ConclusionsCCTA before randomization in ISCHEMIA demonstrated high concordance with subsequent ICA for identification of patients with angiographically significant disease without LM disease.