arterial stiffness parameters

Clin Cardiol. 2012 Jan;35(1):26-31. doi: 10.1002/clc.20999. Epub 2011 Nov 14.
Comparison of aortic and carotid arterial stiffness parameters in patients with verified coronary artery disease.
Gaszner B, Lenkey Z, Illyés M, Sárszegi Z, Horváth IG, Magyari B, Molnár F, Kónyi A, Cziráki A.
Source
Heart Institute, Faculty of Medicine, University of Pécs, Hungary.
Abstract
BACKGROUND:
Arterial stiffness parameters are commonly used to determine the development of atherosclerotic disease. The independent predictive value of aortic stiffness has been demonstrated for coronary events.
HYPOTHESIS:
The aim of our study was to compare regional and local arterial functional parameters measured by 2 different noninvasive methods in patients with verified coronary artery disease (CAD). We also compared and contrasted these stiffness parameters to the coronary SYNTAX score in patients who had undergone coronary angiography.
METHODS:
In this study, 125 CAD patients were involved, and similar noninvasive measurements were performed on 125 healthy subjects. The regional velocity of the aortic pulse wave (PWVao) was measured by a novel oscillometric device, and the common carotid artery was studied by a Doppler echo-tracking system to determine the local carotid pulse wave velocity (PWVcar). The augmentation index (AIx), which varies proportionately with the resistance of the small arteries, was recorded simultaneously.
RESULTS:
In the CAD group, the PWVao and aortic augmentation index (Alxao) values increased significantly (10.1 ± 2.3 m/sec and 34.2% ± 14.6%) compared to the control group (9.6 ± 1.5 m/sec and 30.9% ± 12%; P < 0.05). We observed similar significant increases in the local stiffness parameters (PWVcar and carotid augmentation index [Alxcar]) in patients with verified CAD. Further, we found a strong correlation for PWV and AIx values that were measured with the Arteriograph and those obtained using the echo-tracking method (r = 0.57, P < 0.001 for PWV; and r = 0.65, P < 0.001 for AIx values).
CONCLUSIONS:

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突然死を予防するには心電図検査が重要

ECG Worthwhile for Pre-Sports Check-Up
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: April 23, 2013
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania

Action Points
Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
There is controversy concerning the most effective screening strategy for youngsters participating in sports. The European Society of Cardiology advocates the use of the 12-lead ECG, while the American Heart Association does not, placing emphasis on symptoms.
In one study reported here, a pre-sports participation exam that included a 12-lead ECG turned up group 2 findings in less than 8% of young people, a small fraction of whom had pathology confirmed on further work-up. Another study found a larger percentage of electrocardiographic abnormalities in a population of apparently healthy young people.
ROME -- Screening students before participation in sports with an electrocardiogram to pick up potentially deadly cardiac problems is worthwhile, two European studies argued.
A pre-sports participation exam that included a 12-lead ECG turned up group 2 findings in 7.8% of young people, 0.44% of whom had pathology confirmed on further work-up, Jakir Ullah, MD, of St. George's University of London, and colleagues found.
Self-reported symptoms weren't useful, as 40% reported them but none turned out related to cardiac pathology, the group reported here at the European Association for Cardiovascular Prevention and Rehabilitation's EuroPRevent meeting.
"If you're going to do it for the reason of detecting cardiac pathology, then you really need to be exhaustive," Ullah told MedPage Today. "Not including the ECG, you on the one hand end up investigating too many people based on symptoms and possibly missing people who don't have symptoms but do have ECG changes."
A separate study screening all Italian teens rather than just those going out for sports found a 21% rate of pathological ECG, Maria Chiara Gatto, MD, of "La Sapienza" University of Rome, and colleagues reported at the meeting as well.
"It's important to perform an ECG not only in young competitive athletes but also in noncompetitive athletes and nonathletes as there is a high prevalence of ECG abnormalities in the young general population," Gatto's group concluded.
The European Society of Cardiology advocates for use of a 12-lead ECG for pre-participation screening; whereas the American Heart Association recommends taking a history and physical examination without the ECG.
Ullah's study included screening of 15,027 individuals ages 14 to 35 over a 5-year period, using a health questionnaire to collect symptoms and family history, a 12-lead ECG, and consultation with a cardiologist.
The most common symptoms reported were chest pain and pre-syncope at around 16% each. Syncope, palpitations, and dyspnea were reported by 8% to 10%.
However, 96% of these individuals with reported symptoms had a normal ECG. The rest were cleared either by the cardiologist at the initial session or after a referral for 0.6%.
The overall false positive rate was 36% for symptoms but 7.4% with group 2 ECG findings on screening.
The positive predictive value of symptoms was 0% and 4% for group 2 ECG findings.
"If pre-participation screening is advocated, it must include a 12-lead ECG," Ullah argued.
The individuals who did turn out to have pathology included four cases of Brugada syndrome, 29 cases of Wolf-Parkinson-White, one case of hypertrophic cardiomyopathy, three cases of arrhythmogenic right ventricular cardiomyopathy, eight cases of long QT interval, and other congenital defects in 22 cases.
In Gatto's study, all high school students (ages 16 to 20) were screened with an ECG done by volunteer physicians and transmitted to a reading center.
The 27% with "almost normal" ECGs included mostly right ventricular conduction delay, as well as some early repolarization, left or right axis deviation, sinus tachycardia, and sinus bradycardia.
The pathological ECGs included:
2.09% suspected Brugada syndrome
3.25% supraventricular arrhythmias
1.08% ventricular arrhythmias
0.91% AV block
4.50% fascicular block
1.55% right or left complete bundle branch block
3.69% pre-excitation
0.98% atrial enlargement
0.61% long or short QT intervals
4.50% abnormal ventricular repolarization
0.47% left ventricular hypertrophy
Less than 0.2% junctional rhythm
Less than 0.3% coronary sinus rhythm
Gatto suggested a national program of screening to reduce sudden cardiac deaths among young people and proposed that the volunteer physician program made it cost-effective.
A national screening program in the U.S. has been projected to cost upwards of $10.6 million per life saved, with a tab of at least $52 billion over a 20-year period to save about 4,800 lives.
Most groups have called it too expensive for the potential benefit, although some say it is getting less expensive as ECG machine prices drop.
The cost of the screening itself isn't the only challenge, as the significant false positive rate contributes to anxiety and costs as well, Hugo Saner, MD, of the University of Bern, Switzerland, commented in an interview.
One reason for the substantially high rate of pathology found in the Italian cohort may have been because of particular characteristics of the population there that would limit generalizability, added Sidney Smith, MD, a past president of the American Heart Association and the World Heart Federation.
"Previous studies showing benefit [of a 12-lead screening] have been primarily from northern Italy where there is a high prevalence of genetic abnormalities that can lead to death," he cautioned.

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小児先天性心疾患は、発見が遅れることが多いと指摘

Congenital Heart Disease Often Detected Late Nancy A. Melville Nov 06, 2012 SAN FRANCISCO, California — Infants born in level 1 or 2 nurseries have higher levels of late detection of critical congenital heart disease (CCHD), and more cases at such centers are missed, according to research presented here at the American Public Health Association 140th Annual Meeting.

Researchers evaluated infants born with 12 types of CCHD from 1998 to 2007 using the Florida Birth Defects Registry and hospital discharge records.
The infants were identified as having a late detection of CCHD if the records showed no International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code indicating congenital heart disease on the birth hospitalization record.
There were no significant differences on measures of maternal race, ethnicity, or maternal age or education; however, there was a big difference in the level of nursery care at the birth hospital.
The unadjusted prevalence ratio of being undetected at a level 1 nursery to being undetected at a level 3 nursery was 4.9; the ratio of undetection at a level 2 to a level 3 nursery was 3.3.
Which Congenital Defects Are Most Likely to Be Detected Late?
The rate of late detection was 36.8% for coarctation of the aorta and 24.0% for tetralogy of Fallot.
"The association between a level 1 or 2 birth hospitalization nursery and delayed detection suggests that universal newborn screening for CCHD could be particularly beneficial" in these settings, she added.
CCHD Added to Screening Panel in 2011

http://www.medscape.com/viewarticle/773929_print
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In the final sample of 3603 infants, 2778 were diagnosed with CCHD in a timely manner, but 825 did not have a CCHD diagnosis on their hospital discharge record (an undetected prevalence rate of nearly 23%).
Coarctation of the aorta, tetralogy of Fallot, aortic arch atresia/hypoplasia, total anomalous pulmonary venous connection, and truncus arteriosus were significantly more likely to have been detected late than hypoplastic left heart syndrome.
"To our knowledge, this is the first study to investigate...late detection in infants and, as we expected, the type of CCHD was associated with timely detection," said coauthor April Dawson, MPH, from the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention in Atlanta, Georgia.
In response to concerns about timely CCHD detection, Kathleen Sebelius, secretary of the US Department of Health and Human Services, approved the addition of CCHD to the Recommended Uniform Screening Panel in October 2011.
The Secretary's Advisory Committee on Heritable Disorders in Newborns and Children identified 7 specific lesions as primary targets for screening with pulse oximetry: hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus.
After the approval, New Jersey became the first state to mandate CCHD screening for all newborns; since then, 9 states have enacted similar legislation and 9 others have introduced legislation for mandated screening. In other states, many hospitals have implemented voluntary screening.
2012/11/11

Moving in the Right Direction
According to Marianne M. Hillemeier, PhD, MPH, from the Department of Health Policy and Administration at Pennsylvania State University in University Park, the late detection rate found in this study is troubling, but the new recommendations suggest movement in the right direction.
"I think it is very clinically significant that 23% of congenital heart conditions were not diagnosed until after the newborn hospitalization," she said. "I expect that recommendations for early screening will improve this situation," she said.
The findings also highlight the need for improved awareness at level 1 and 2 nurseries, Dr. Hillemeier added.
Ms. Dawson and Dr. Hillemeier have disclosed no relevant financial relationships.
American Public Health Association (APHA) 140th Annual Meeting. Abstract 262258. Presented October 30, 2012.

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Cite this article: Congenital Heart Disease Often Detected Late. Medscape. Nov 06, 2012.