Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction

BACKGROUND: Risk stratification after uncomplicated myocardial infarctionis a major clinical problem. In particular, the prognostic valueof residual inducible ischaemia is still controversial. We comparedthe relative prognostic value of exercise ECG and dobutaminestress echocardiography performed in the early post-infarctionperiod. METHODS: Four hundred and six patients (53 female) aged 57 ± 9years, undergoing maximal exercise ECG and dobutamine stressechocardiography within 10 days of an uncomplicated myocardialinfarction off therapy, were prospectively followed-up for 8·8months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia,infarct location, thrombolysis and resting wall motion scoreindex were taken into account among clinical variables. Prognosticcorrelations were made vs spontaneous events (cardiac death,non-fatal reinfarction and unstable angina requiring hospitalization)whilst patients undergoing revascularization (by means of percutaneoustransluminal coronary angioplasty or coronary artery bypasssurgery) at the time of the procedure were censored. RESULTS: One hundred and twenty-seven events occurred during the follow-up:41 (10%) were spontaneous (five deaths, 12 reinfarctions and24 unstable angina) and 86 procedural (27 angioplasty and 59bypass surgery). Spontaneous events were not predicted by anyclinical, exercise ECG or dobutamine stress echocardiographyvariable, but the negative predictive value of both tests wasexcellent (91% and 90%, respectively). With a multivariate Coxanalysis, male gender, positive low-workload (<100 W) exerciseECG (P<0·0001), positive low-dose dobutamine stressechocardiography (P<0·0001) and reststress wall motionscore index variation (P<0·001) were found to predictcumulative cardiac events with an independent and additive value.Dobutamine stress echocardiography was significantly more sensitive(P<0·05) and less specific (P<0·01) in predictingthe outcome of patients with anterior infarction, whilst exerciseECG was significantly more sensitive (P<0·05) in patientswith non-Q wave infarction. CONCLUSION: (1) Spontaneous events are poorly predicted by provocative testsin low-risk patients after uncomplicated myocardial infarction.(2) However, both exercise ECG and dobutamine stress echocardiographycan predict a favourable outcome with a very high negative predictivevalue. (3) Dobutamine stress echocardiography should be considereda secondary option in cases where the exercise ECG is equivocalor when the location of ischaemia is a relevant issue. (4) Thepossibility that the two tests have a differential utility dependingon the infarct location and type (Q wave vs non-Q wave) maybe clinically relevant and deserves further evaluation.     

The pathogenic role of the GIP/GIPR axis in human endocrine tumors: emerging clinical mechanisms beyond diabetes

Reviews in Endocrine and Metabolic Disorders - The glucose-dependent insulinotropic polypeptide (GIP) is an incretin hormone produced in the gastrointestinal tract in response to nutrients. GIP has...     

通脉注射液抗血栓形成作用及对血液流变性的影响

目的:研究通脉注射液治疗缺血性心脑血管疾病的药效学。方法:研究通脉注射液对高分子右旋糖酐所致大鼠动物模型血液流变学特性的影响、对大鼠体内静脉血栓形成的影响、对家兔心血体外血栓形成的影响、对大鼠下腔静脉血栓溶解的影响。结果:通脉注射液可明显改善血瘀大鼠红细胞变形能力及其聚集性,降低红细胞压积及全血粘度与血浆粘度,抑制大鼠静脉血栓及家兔心血体外血栓的形成,促进大鼠下腔静脉血栓的溶解;对ADP诱导的血小板聚集有明显抑制作用,并能减少血小板细胞的粘附性。结论通脉注射液有明显的活血通脉作用。     

Prevalence of dental caries in preschool children born preterm and/or with low birth weight: A systematic review with meta‐analysis of prevalence data

The aim of the present systematic review and meta‐analysis was to evaluate the prevalence of dental caries among preschool children who had been born preterm and/or with low birth weight (LBW) compared with those who had been born full term and/or with normal birth weight (NBW). Eight electronic databases were searched from interception up to November 2018 with no restrictions imposed regarding the date of publication or language. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A random‐effects meta‐analysis was run to pool the crude prevalence of dental caries according to gestational age and birth weight. We performed a narrative synthesis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Fifty‐nine observational studies were included (55 in the meta‐analysis). The prevalence of dental caries was 39% among preterm children, 30% among full‐term children, 40% among LBW children, and 33% among NBW children (I²:97%‐99%). The majority of studies reported that dental caries was not associated with gestational age or birth weight, with very low certainty of evidence. Preschool children born preterm or with LBW have similar dental caries experience as those born full term or with NBW, with very low certainty of evidence (PROSPERO #CDR42018118086).     

High-resolution computerized tomography. Staging of lobular lesions in cystic fibrosis]

Forty-four patients affected with cystic fibrosis (CF) were examined by means of high-resolution Computed Tomography (HRCT) of the chest; the sensitivity of this technique was evaluated in identifying small pulmonary structure alterations, and its role outlined. In all cases, HRCT scans allowed early lobular shape anomalies to be detected and secondary pulmonary lobular lesions to be correlated with disease evolution. A classification for lobular lesions was proposed: Stage I - Thickening of the bronchovascular bundle and/or intralobular septa and/or middle interstitial compartment. Unessential changes in lobular ventilation. Preservation of lobular shape. Stage II - Intralobular emphysema. Acinar filling with normal ventilation (A) or diffuse hypoventilation of the lobule (B). Preservation of lobular shape. Stage III - Lobular consolidations. Preservation of lobular shape. Stage IV - Patch distribution of lesions characterized by derangement of lobular structures. Changes in normal lobular shape. The identification of these lesions confirms HRCT as the most sensitive technique for the early visualization and localization of signs of CF bronchopneumonopathy. A broader experience coming from the systematic use of HRCT in chronic inflammatory lung diseases would increase our knowledge of pathogenetic processes and allow therapeutic perspectives to be improved.     

Acute effects of diltiazem in pulmonary hypertension secondary to chronic obstructive bronchitis

The effect of acute i.v. administration of diltiazem on pulmonary haemodynamics was compared to that produced by oxygen in 10 hypoxemic patients with chronic obstructive lung disease and pulmonary hypertension (PAPm greater than 20 mmHg), without left ventricular dysfunction. Determinations were carried out at baseline, during 100% oxygen inhalation, at least 20 minutes after oxygen withdrawal and 15 minutes after i.v. diltiazem loading dose of 0.25 mg/kg followed by the infusion of 1 mcg/kg/min. Oxygen inhalation produced no significant modifications of haemodynamic variables, whilst a significant (p less than 0.05) decrease of PAPm, pulmonary arteriolar resistance (PAR) and peripheral resistance (TPR) was observed after diltiazem administration (respectively 14%, 23% and 11.6%). Heart rate, cardiac index and blood pressure did not change significantly even with diltiazem. These results could support the inclusion of diltiazem in the therapeutic regimen of pulmonary hypertension due to chronic obstructive lung disease, but further investigations are needed to clarify the predictive value of its acute administration in assessing long term efficacy.     

Prognostic usefulness of dobutamine-induced ST-segment elevation and T-wave normalization after uncomplicated acute myocardial infarction

We followed 229 consecutive patients exhibiting negative T waves on infarct-related electrocardiographic leads; these patients underwent dobutamine stress echocardiography within 10 days after a first uncomplicated acute myocardial infarction. T-wave normalization, but not ST-segment elevation, recognized patients at higher risk of cardiac events and optimized the prognostic accuracy of both myocardial viability and ischemia, to which it was correlated and became an independent predictor in cases of subdiagnostic stress echocardiography.