Which concentration to choose in dual flow cardiac CT?: Dual flow cardiac CT

Purpose

An extensive number of protocols have been suggested to allow for functional diagnostics; however, no data is available about the minimal amount of contrast medium to achieve reliable imaging properties. None of the plethora of existing studies report a rational why the specific concentration was chosen.

Materials and methods

A total of 40 patients were included in this prospective, controlled study. They were divided up into four equal groups getting a different concentration (10%, 20%, 30% or 40%) of a second contrast medium bolus. Corresponding septal and right ventricular ROIs were compared. A visual score was established. Coronary attenuation was measured in the right and left coronary artery. Streak artifacts in the right atrium/ventricle were assessed.

Results

In the 10% contrast medium (CM) group only in 5/10 (50%) patients full septal delineation was reached. In all other groups full septal visualization was obtained.No group showed a relevant difference of mean density measured in HU units of the left ventricle or the coronary arteries. All study groups except of group 1 (10% CM) showed streak artifacts in the right atrium.

Conclusion

The dual flow protocol with a minimum concentration of 20% improves septal visualization as basis for left ventricular functional assessment, however, does not allow for reliable right ventricular or atrial visualization.There is no significant difference between the different concentration protocols in terms of coronary attenuation.     

Prognostic Value of Quantitative Stress Perfusion Cardiac Magnetic Resonance

Objectives

This study sought to evaluate the prognostic usefulness of visual and quantitative perfusion cardiac magnetic resonance (CMR) ischemic burden in an unselected group of patients and to assess the validity of consensus-based ischemic burden thresholds extrapolated from nuclear studies.

Der innerklinische Utstein-Style (Teil II)

Diese wissenschaftliche Stellungnahme der American Heart Association, des European Resuscitation Council, der Heart And Stroke Foundation of Canada, des Australian Resuscitation Council und des Resuscitation Council of Southern Africa ist das Ergebnis des 95er Utstein Symposions, das vom 23.–24.06.1995 in der Utstein Abtei auf der Insel Mosteroy im Rogaland County in Norwegen stattfand. Der erste Teil dieser Stellungnahme wurde in der letzten Ausgabe von Notfall & Rettungsmedizin (2/98) publiziert.     

Der innerklinische Utstein-Style (Teil I)

Diese wissenschaftliche Stellungnahme der American Heart Association, des European Resuscitation Council, der Heart And Stroke Foundation of Canada, des Australian Resuscitation Council und des Resuscitation Council of Southern Africaist das Ergebnis des 95er Utstein Symposions, das vom 23. - 24. 06.1995 in der Utstein Abtei auf der Insel Mosteroy im Rogaland County in Norwegen stattfand. Erste Entwürfe wurden mit der Bitte um Stellungnahme an alle teilnehmenden Organisationen verschickt: an das Exekutivkommitee des European Resuscitation Council, das Emergency Cardiac Care Committee der American Heart Association (AHA), das Exekutivkommittee der Heart and Stroke Foundation of Canada, das Australian Resuscitation Council, das Resuscitation Council of Southern Africa und an einige unabh?ngige Gutachter. Die Erarbeitung dieser Stellungnahme wurde von dem Science and Coordinating Committee der AHA und dem Exekutiv- komitee des European Resuscitation Council unterstützt.     

Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines

Objective

We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases.

Methods

Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on “depression and CHD,” supplemented by more focused literature searches.

Results

Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively.

Conclusion

We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD.     

Proprotein convertases in human atherosclerotic plaques: the overexpression of FURIN and its substrate cytokines BAFF and APRIL

Background

Proprotein convertase subtilisin/kexin (PCSK) enzymes cleave proproteins into mature end products. Previously, MBTPS1 and PCSK9 have been shown to regulate cholesterol metabolism and LDL receptor recycling, whereas FURIN and PCSK5 have been suggested to inactivate lipases and regulate inflammation in atherosclerosis. Here, we systematically analyzed the expression of PCSKs and their targets in advanced atherosclerotic plaques.

Methods and results

Microarray and quantitative real-time PCR experiments showed that FURIN (42.86 median fold, p = 2.1e−8), but no other PCSK, is universally overexpressed in the plaques of different vascular regions. The mRNA expression screen of PCSK target proteins in plaques identified many known factors, but it also identified the significant upregulation of the previously overlooked furin-processed B cell activating cytokines APRIL (TNFSF13, 2.52 median fold, p = 3.0e−5) and BAFF (TNFSF13B, 2.97 median fold, p = 7.6e−6). The dysregulation of FURIN did not associate with its htSNPs or the previously reported regulatory SNP (−229, rs4932178) in the promoter. Immunohistochemistry experiments showed the upregulation of FURIN in the plaque lymphocytes and macrophages where it was co-expressed with BAFF/TNFSF13B and APRIL/TNFSF13.

Conclusions

Our data unequivocally show that FURIN is the primary PCSK that is dysregulated in the immune cells of advanced human atherosclerotic plaques, which implies a role for this enzyme in plaque pathology. Therefore, drugs that inhibit FURIN in arteries may modulate the course of this disease.