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PubMed2006

Prognostic value of high-sensitivity C-reactive protein in patients with chronic heart failure.

OBJECTIVE: To determine whether high-sensitivity C-reactive protein (hsCRP) has prognostic value in patients with chronic heart failure. METHODS: Serum hsCRP levels were measured with high-sensitivity assay (IMMAGE Immunochemistry Systems) in 128 patients with CHF and 25 healthy control subjects. Cardiac troponin T (TNT) was measured by electrochemiluminescence immunoassay on an Elecsys1010 automatic analyser. Cardiac events were defined as cardiac death and rehospitalisation because of worsening heart failure during the follow-up period. RESULTS: Circulating levels of hsCRP and TNT were significantly higher in patients with CHF than in the 25 healthy people (p=0.0028, p=0.017, respectively) and increased with severity of CHF. During a mean follow-up period of 378 +/- 26 days, 42 (32.8%) of the 128 patients had cardiac events. Levels of hsCRP and TNT were significantly higher (p=0.00031, p=0.00047, respectively) and LVEF was significantly lower (p=0.0052) in patients with cardiac events than in patients without cardiac events. When multivariate Cox proportional hazards regression was performed, we found that hsCRP, TNT, and LVEF were independent significant predictors of cardiac events in patients with CHF (hsCRP: hazard ratio [HR], 3.81; 95% confidence interval [CI], 2.14-9.35; p=0.024; TNT: HR, 2.61; 95%CI, 1.96-4.31; p=0.012; LVEF: HR, 3.52; 95%CI, 2.36-10.37; p=0.024). When Pearson's correlation analyses were performed, we could find a positive correlation between hsCRP and TNT (r=0.493, p=0.0043) and a negative correlation between hsCRP and LVEF(r=-0.354, p=0.0051). CONCLUSION: Serum hsCRP concentrations were elevated in patients with CHF and increased with severity of CHF. It was an independent significant predictor of cardiac events in patients with CHF.

C-Reactive Protein↗

PubMed1991

Silent myocardial ischemia after percutaneous transluminal coronary angioplasty and its prognostic significance.

A cohort of 175 patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) were subjected to a treadmill exercise test to determine the prognostic significance of silent and symptomatic myocardial ischemia during the follow-up (average 11.7 months). The cardiac events during the follow-up were defined as cardiac death, nonfatal myocardial infarction, class III angina, and need for repeat angioplasty or coronary artery bypass surgery. During exercise, 39 patients (22%) had abnormal exercise-induced ST depression without chest pain (Group I). A group of 22 patients (13%) had both exercise-induced chest pain and ST-segment depression (Group II), and 114 patients (65%) had normal exercise test and no chest pain (Group III). The groups were similar in sex distribution, history of previous myocardial infarction, distribution of vessel disease, and presence of left ventricular dysfunction. Group III included more patients with complete revascularization. Follow-up data revealed that cardiac event rates in Groups I and II were significantly higher than in Group III (41%, 41%, vs. 16%) (p less than 0.01). The event rates in Groups I and II with multivessel angioplasty also were significantly higher than in Group III (58%, 61%, vs. 21%) (p less than 0.01). Exercise-induced silent myocardial ischemia is frequently seen early after successful PTCA and is more prevalent in patients undergoing multivessel angioplasty and incomplete revascularization. Both silent and symptomatic ischemia early after PTCA are predictors of an unfavorable prognosis.

Angioplasty, Balloon, Coronary↗

PubMed1987

Gastrojejunostomy: is it helpful for patients with pancreatic cancer?

A retrospective review of palliative outcome of gastrojejunostomy in patients with pancreatic cancer was conducted. Eighty-one patients were analyzed in two groups depending on duodenal patency. Forty-five patients (group I) had no evidence of duodenal obstruction. Thirty-six patients (group II) had evidence of impingement on the duodenum by the pancreatic cancer. A third subset of patients was also studied for outcome. These 21 patients (five group I and 16 group II) had nausea and vomiting as major symptoms and were judged to have the most to gain from gastrojejunostomy. Patients were categorized by outcome. Poor outcome was defined as either death during the hospitalization for gastrojejunostomy or death within 30 days of operation even if the patient left the hospital. Risk for poor outcome depended on group. In group I, 18 of 45 patients (40%) had a poor outcome compared with 25 of 36 (70%) patients in group II (p less than 0.001). Nineteen of the 21 (90%) patients with nausea and vomiting had a poor outcome. It is an unfortunate paradox that the more patients need gastrojejunostomy for pancreatic cancer, the less likely they are to have a favorable outcome. Gastric outlet obstruction in pancreatic cancer appears to be a terminal event. A prospective study is needed to see if any true palliation of vomiting can be affected in these patients.

Adult↗

PubMed1989

Pregnancy outcomes after increasing maternal serum alpha-fetoprotein levels.

Five hundred sixty women among 35,787 screened had an initial maternal serum alpha-fetoprotein (MSAFP) of 2.5 or more multiples of the median. They were divided into three groups: group 1, 2.5-2.9; group 2, 3.0-3.9; and group 3, over 4.0 multiples of the median. These groupings determined the relationship to adverse pregnancy outcome, defined as fetal death, fetus with significant anomalies, and prematurity/growth retardation. The overall risk of adverse outcome after an initial elevation was 38%, after excluding pregnancies with incorrect dates or multiple gestations with levels below 4.5 multiples of the median: 27, 39, and 45% in groups 1, 2, and 3, respectively. This risk rose to 86% for levels over 6.0 multiples of the median. There was a significant positive correlation between abnormalities and death detected with ultrasound and amniocentesis and those indicated by increasing MSAFP levels: 10, 20, and 31% in groups 1, 2, and 3, respectively. After normal ultrasound and amniocentesis studies, there was a trend toward increasing risks for fetal death after 20 weeks between groups 2 and 3 (5 and 11%), but not for growth retardation/prematurity (12, 17, and 13%). After an elevated MSAFP, the overall risk of a late pregnancy complication after normal ultrasound and amniocentesis was 22%: 19, 23, and 25% in groups 1, 2, and 3, respectively. This figure increased to 67% for levels above 6.0 multiples of the median.

Amniocentesis↗

PubMed1989

Obstetric risk assessment in rural practice.

A study was undertaken to evaluate Coopland's obstetric risk index in a rural primary care setting. Information on 635 pregnant women cared for in a rural practice was collected prospectively. Adverse outcome was defined as perinatal death, birthweight less than 2500 g, 5-minute Apgar score less than 7, or newborn transferred to a level 2 or level 3 nursery. Forty-seven pregnancies (8.3%) had an adverse outcome. There was a clear relationship between risk score and probability of adverse outcome. Good sensitivity could be achieved only at the expense of a very high false-positive rate, however. The index can be used to identify a subgroup of women at relatively high risk for adverse outcome, but the majority of adverse outcomes will occur in women identified as low risk. The risk-scoring system in this population was no more effective than a policy that would refer all women with standard obstetric risk factors.

Adult↗

PubMed1979

[Effects of injurying and restoring the body of mice with microwave (2400 MHz) irradiation].

In the experiments on 2200 mice the thresholds of powder density (PD) and time of irradiation were defined, when the death level did not exceed 0.1%. Dependence between the speed ratio of the destruction/regeneration and PD approached the exponential function. The functional dependences obtained quantitatively characterize the adaptive abilities of the mouse organism exposed to microwave irradiation.

Animals↗

PubMed1975

Prognostic grading and significance of ventricular premature beats after recovery from myocardial infarction.

A 6-hour taped electrocardiogram recording was obtained prior to hospital discharge on 193 patients less than 66 years of age with a definite or probable myocardial infarction. All ventricular premature beats (VPBs) were identified on the 6-hour recording, and the various VPB characteristics were related to a complicated course (CC) defined as cardiac death or myocardial reinfarction within 4 months after hospital discharge. Only three univariate VPB characteristics (multiform pattern, bigeminal rhythm, and frequency greater than or equal to 20/hr) were significantly associated with a 4-month posthospital CC. By use of bivariate and multivariate combinations of these three VPB characteristics, a two-grade prognostic stratification system was derived: Grade I VPBs (CC = 8%) included patients with less than 20 VPB/hr but with neither multiform nor bigeminal beats: Grade II VPBs (CC = 31%, P less than 0.001) contained patients with greater than or equal to 20 VPBs/hr or with multiform or bigeminal beats or both. Patients with Grade II VPBs had more severe cardiac disease, but when patients were stratified by the clinical severity of their cardiac disease, Grade II VPBs identified patients with higher CC rates. The clinical significance of these findings together with a critical analysis of the prognostic stratification method are discussed.

Aged↗

PubMed1984

Rheumatic fever and rheumatic heart disease in Serbia Proper, Yugoslavia, 1970-1979.

The occurrence of rheumatic fever and rheumatic heart disease in the period 1970-1979 is analysed on the basis of morbidity and mortality data. It was found that: Rheumatic fever first attacks rate and rheumatic fever recurrent attacks rate in 1979 were by 80% and 91% lower respectively, compared with 1970 rates; The disease became milder and the number of RF with heart involvement decreased especially in population over 19 years old; In the ten year period mortality rate from rheumatic fever and rheumatic heart disease decreased 2.8 times; In the age group 15-24 mortality did not decline so noticeable and mortality rate in this age group is still ten times higher than the same rate in the most developed countries; Among all defined causes of death (except accidents), in the age group 15-24, rheumatic fever and rheumatic heart disease (taken together) fell from first or second place to the eleventh or tenth place in the last years under review; One can expect that the declining trend of morbidity and mortality from rheumatic fever and rheumatic heart disease will continue though probably slower then in the preceding period.

Adolescent↗

PubMed1995

Metaanalysis in clinical chemistry: validation of cardiac troponin T as a marker for ischemic heart diseases.

Metaanalysis is a method that incorporates the pooling of previously published results to produce more statistically significant results. We used metaanalysis to examine the role of a new cardiac marker, cardiac troponin T (cTnT), in patients with ischemic heart disease. Metaanalysis of six articles and one abstract on cTnT showed that this marker was just as sensitive as creatine kinase MB isoenzyme (CK-MB) for the retrospective diagnosis of acute myocardial infarction (AMI) 12-48 h after onset but less specific. Most of these articles showed that cTnT was increased in non-AMI patients with unstable angina pectoris. In a metaanalysis of four papers, two abstracts, a letter, and an unpublished manuscript, we examined the prognostic role of cTnT in non-AMI cardiac patients. For an unfavorable endpoint defined as cardiac death, AMI, or the need for coronary artery revascularization, the results demonstrated that abnormal concentrations of cTnT were associated with a higher risk for a poor outcome than were normal concentrations of cTnT. We also compared cTnT with CK-MB for risk stratification. Metaanalysis will become an increasingly important tool for evaluating new tests as they become available.

Biomarkers↗

PubMed1994

Prognostic value of normal technetium-99m-sestamibi cardiac imaging.

UNLABELLED: The purpose of this study was to describe the clinical outcome of patients with a normal 99mTc-sestamibi cardiac imaging study. METHODS: One-day gated rest-stress planar dipyridamole (n = 112) and symptom-limited exercise (n = 122) 99mTc-sestamibi protocols were used. All patients (n = 234, mean age 55 +/- 12 yr, 127 males and 107 females) had normal perfusion and wall motion on qualitative analysis. Patients were followed for 6-16 mo (mean 10 +/- 2 mo). Cardiac events were defined as cardiac death or nonfatal myocardial infarction. RESULTS: ST-segment depression or chest pain occurred in 8 (7%) and 29 (26%) patients in the dipyridamole group, respectively, and 20 (16%) and 28 (22%) patients in the exercise group. Cardiac events occurred in only one patient. The annualized event rate was 0.5% per year. In addition, only two patients underwent coronary revascularization during the follow-up period. CONCLUSIONS: Our data confirm the benign outcome of patients with normal 99mTc-sestamibi cardiac imaging, at least over an intermediate follow-up period.

Aged↗

PubMed1993

Impact of antianginal medications, peak heart rate and stress level on the prognostic value of a normal exercise myocardial perfusion imaging study.

We sought to determine whether antianginal medications or the level of achieved stress affect the prognostic value of a normal exercise 201Tl study. We studied 261 patients with a normal exercise 201Tl study for 23 +/- 6 mo. Antianginal medications were taken at the time of stress testing in 128 patients. Peak heart rate ranged from 82 to 217 bpm; percent maximal predicted heart rate ranged from 42% to 136%. Chi-square analysis was used to determine the relationship of cardiac events to antianginal medications and stress indices. Primary cardiac events were defined as cardiac death or nonfatal myocardial infarction. Primary cardiac events occurred in six patients yielding an annual incidence of 1.2% per year. There was no significant relationship between cardiac event rate and antianginal medication use or any stress index, including Bruce stage, peak heart rate or blood pressure or percent maximal predicted heart rate achieved. The risk of cardiac death or nonfatal myocardial infarction in patients with a normal exercise 201Tl is low and is not affected by concurrent antianginal treatment or degree of stress achieved.

Angina Pectoris↗

PubMed1993

Transplanted neocortical neurons migrate selectively into regions of neuronal degeneration produced by chromophore-targeted laser photolysis.

Selective degeneration of neocortical callosal pyramidal neurons by noninvasive laser illumination was used for directed studies of neocortical transplantation, to test the hypothesis that transplanted embryonic neurons may seek to restore normal cytoarchitecture within an appropriately permissive local environment. At long wavelengths that penetrate through tissue without major absorption, photolysis can cause extremely selective degeneration to desired subpopulations of targeted neurons in vivo (Macklis and Madison, 1991; Madison and Macklis, 1993). Cell death is geographically defined and slowly progressive, allowing control over the anatomical substrate for transplantation. Targeting occurs by retrograde incorporation of cytolytic chromophores that are activated by specific-wavelength light. Intermixed neurons, glia, axons, blood vessels, and connective tissue remain intact. Degeneration was effected within neocortical lamina II/III of neonatal mouse pups following targeting in utero or early postnatally with photoactive nanospheres. Total neuron density was reduced typically by 25-30% within defined areas, with approximately 60% loss of large projection neurons and no change in the number of small, presumptive interneurons. Embryonic day 17 neocortical cell suspensions, which included recently postmitotic neurons destined to form lamina II/III, were transplanted lateral to these regions of ongoing neuron degeneration in juvenile mice. Cellular injections spanned laminae II-V, to provide donor neurons with both lateral and laminar choice for possible migration and integration. Donor cells were labeled in vitro with unique fluorescent and electron-dense nanospheres that allowed distinct identification of donor cells at both light and electron microscopic levels. Control experiments included neocortical transplants into intact age-matched hosts, into hosts with kainic acid lesions to neocortex, or distant to the region of photolytic neuronal degeneration; embryonic cerebellar transplants to the regions of selective photolytic degeneration; and grafts of hypoosmotically lysed neocortical cells to lesioned regions. After survival times of 1 hr to 12 weeks, labeled neurons were identified morphologically and positions were digitized for qualitative and quantitative analysis of position and specificity of migration and cellular integration; electron microscopy was used to confirm further the donor identities of migrated neurons. Neurons placed near host zones of photolytic neuron degeneration migrated up to 780 microns specifically within these zones; approximately 44% of donor neurons migrated significantly beyond the injection site to enter these regions. Migration and integration did not occur in normal, unaffected deeper layers IV-VI of these experimental mice, or in the normal lamina II/III bordering the transplantation site on the side opposite the neuron-deficient region. Control grafts of all five types revealed only minimal local spread without laminar preference.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1995

[Intestinal infarctions. A re-evaluation of prognostic factors of postoperative mortality].

The aim of this study, based on a series of 67 patients, was to assess the prognostic factors of postoperative mortality of intestinal infarctions (small and large bowel). Known risk factors were studied (age, sex, shock, Concomitant disease, use of arteriography and vasodilators), together with less studied factors, such as recent vascular or cardiac surgery less than 4 months before the infarction and length of bowel infarction. Postoperative mortality was defined as any death occurring within 45 days after surgery. The risk factors were assessed by univariate and multivariate analysis with logistic regression. The postoperative mortality was 63%. Age, shock, other medical diseases, recent cardiovascular surgery, and length of bowel infarction were significant predictive factors of postoperative mortality on univariate analysis. Shock, age greater than 70 years and recent cardiovascular surgery were three independent risk factors selected on multivariate analysis with equivalent weights.

Adult↗

PubMed1996

Prediction of lethal or life-threatening cardio-circulatory events in patients who apparently are not at risk : a preliminary retrospective echocardiographic study.

Major cardio-circulatory events, defined as circulatory death, myocardial infarction, unstable angina, or stroke, sometimes occur unexpectedly in patients who apparently have no evident increase in risk (absence of overt heart failure, hypertrophy, uncontrolled or severe hypertension, previous or present myocardial infarction, angina, myocarditis, infectious or any other pericardial, valvular or great vessel disease, heart malformation, significant arrhythmia or conduction disturbances). To investigate whether 2D-guided M-mode echocardiographic variables have predictive value in such patients, a retrospective analysis of 1,965 cases was performed. Twenty-one patients were found who on the day of echocardiographic examination fulfilled the above criteria, but suffered major cardio-circulatory events during the first following year (1 yr group), 12 during the second year (2 yr group), and 16 during the third year (3 yr group). Twenty-eight patients who fulfilled the same criteria, but were followed-up free of major cardio-circulatory events for 935 +/- 144 days constituted the control group. Multivariate analysis of variance (MANOVA) of echocardiographic data was used to select the final set of 11 variables from 30 measurements and calculations which enabled satisfactory discrimination between the four groups (Hotelling T2 = 3.979, Fisher F = 7.596 > Ftab = 1.585). Extension of MANOVA with the leave-one-out method revealed that none of 28 control patients was predicted to be at risk of major cardio-circulatory events in the next year, and only one of 21 patients from the 1 yr group was misdiagnosed as not being at risk. Patients at risk were older, had slightly greater body size (particularly weight), and slightly increased diastolic diameter and volume of the left ventricle. The left ventricular mass, mean wall thickness, and estimated cross-sectional area indexes were also slightly increased. The peak systolic stress was slightly increased and contractility index (BPS/ESVI) was slightly decreased. Our preliminary results suggest that easily obtained echocardiographic measurements and calculations contain clinically useful predictive information.

Adult↗

PubMed1996

Early detection of prostate cancer in African-American men with an increased familial risk of disease.

Several risk factors for prostate cancer death are well defined. These include age, race (African American), and a family history of prostate cancer. Data also suggest that a family history of breast cancer may provide an additional risk factor for prostate cancer. Despite the fact that these risk factors are well recognized, there are no reports describing a systematic early detection program for prostate cancer in African-American men with an increased familial risk of the disease. In this report, 169 such men between the ages of 40 and 70 are identified. Ninety-five of these men received a prostate-specific antigen and digital rectal examination. The mean age for these 95 men was 52 +/- 8 years; 45.3% were less than age 50. Eighty of these men had a family history of prostate cancer; 15 had a family history of breast cancer. Seventeen men had an abnormal screening test, and 14 subsequently had a prostate biopsy. Four prostate cancers were identified, all within the group of men reporting a positive family history of prostate cancer. In addition to describing the medical aspects of this series, a detailed description of recruiting efforts is also described.

Adult↗

PubMed1996

[Effect of myocardial viability and coronary revascularization on clinical outcome and prognosis: a follow-up study of 161 patients with coronary heart disease].

One hundred and sixty-one consecutive patients (144 male, 57 +/- 9 years) with stable coronary artery disease underwent nuclear imaging for assessment of myocardial viability using Tc-99m sestamibi single-photon emission computed tomography (SPECT) and F-18 fluoro-deoxy-glucose (FDG) positron emission tomography (PET). 88% had a history of chronic myocardial infarction and all had angiographically proven regional wall motion (RWM) abnormalities in the distribution territory of a stenosed or occluded coronary artery. Patients were followed for 29 +/- 6 (22-44) months with 84/161 patients (52%) receiving elective revascularization by either bypass surgery or angioplasty. 61/84 patients underwent follow-up angiography after 5 +/- 2 months for quantitative assessment of RWM changes using serial analysis with the centerline method in 45 pts with technically suitable paired angiograms. Myocardial regions were classified according to semiquantitative analysis of regional sestamibi and FDG uptake as either normal, regions with evidence for maintained viability but no mismatch ("mild match"), regions with a perfusion/metabolism "mismatch," or scar. RWM improved in "mismatch" regions from -2.2 +/- 1.0 SD to -1.0 +/- 1.4 SD (p < 0.01) compared to the mean of a normal reference population. In contrast, in regions with a "mild match" or those classified as scar, RWM analysis revealed no functional changes at follow-up. For the assessment of clinical outcome, patients were divided into three groups depending on the result of viability imaging. Those with predominantly scar tissue in the target region for viability assessment (group A, n = 90), those with a "mild match" (B, n = 26), and group C (n = 45) consisting of patients with a "mismatch" pattern. Subsequent treatment was not blinded to nuclear imaging results and revascularization was performed in 30% of group A (group A2), 81% of group B, and 80% of group C, while the other patients were treated medically only. Cardiac events during follow-up were defined as cardiac death, myocardial infarction, unstable angina with subsequent revascularization, cardiac transplantation, and survived resuscitation without evidence for myocardial infarction. Group C demonstrated a significant reduction of cardiac events from 22% to 0% following revascularization, whereas in group A coronary revascularization did not influence the frequency of events. Subjective assessment of angina pectoris and heart failure symptoms revealed more patients with improvement following revascularization as compared to those treated medically. Thus, combined nuclear imaging using sestamibi SPECT and FDG PET with quantitative tracer uptake analysis allows detection of absent or preserved myocardial viability in regions with reduced perfusion and function with prognostic implication for regional myocardial functional outcome as well as for identification of patients who benefit most from coronary revascularization.

Adult↗

PubMed1997

Drownings in Mississippi 1992-1994: frequencies and distribution.

This investigation was conducted to determine the mortality rate due to drownings in Mississippi from 1992-1994. Drownings were defined as unintentional deaths from asphyxia while submerged or within 24 hours of submersion. Death certificate data including ICD-9 codes related to drownings, were received from the Mississippi State Department of Health. Variables assessed included age, age category, sex, race, death month, death day, place of drowning, and risk factors. Although drownings occurred in ages from 0-91 years, the highest mortality rates were found in the 14-17 year old age category (1 1.9 deaths per 100,000). Asian and Native American populations had the highest drowning mortality rates (23.6 and 22.6 per 100,000) when analyzed by race. However, this may be primarily due to lower populations. Males drowned five times more frequently than women. This is felt to be related to increased exposure. More drownings occurred on Saturdays and Sundays; and in the months of July, June; May, April, September, and August consecutively. Results presented here identify correlates of drowning fatalities which will enable strategic targeting of prevention programs and resources.

Adolescent↗

PubMed1997

The prognostic impact of immunosuppression and cellular rejection on cardiac allograft vasculopathy: time for a reappraisal.

BACKGROUND: Our current immunosuppressive strategies have made little impact on the development of cardiac allograft vasculopathy, the leading cause of long-term allograft loss. This study sought to evaluate the relationship of cellular rejection and immunosuppressive therapy with the development of morbid events resulting from cardiac allograft vasculopathy. METHODS: The study population consisted of 163 consecutive patients who received heart transplants between January 1990 and May 1994. Data regarding nonimmunologic risk factors (lipids, obesity indexes, hypertension, donor age and sex, cytomegalovirus infection, diabetes mellitus, time after transplantation, and cold ischemic time), immunologic factors (histocompatibility, episodes of treated rejection, and average first-year biopsy rejection score), and immunosuppressive regimens (cumulative prednisone dose, average daily prednisone dose, mean cyclosporine level, average cyclosporine daily dose, cumulative azathioprine dose, and average daily azathioprine dose) were collected and analyzed in all patients. The diagnosis of cardiac allograft vasculopathy was established in all patients by a combination of necropsy, angiography, and intravascular ultrasound examination of the allograft vasculature. Cardiac events were defined as sudden death, myocardial infarction, and need for revascularization. RESULTS: Of all variables assembled, stepwise logistic regression recognized cumulative prednisone dose > 15 gm (relative risk [RR] 5.7; p = 0.01), donor age > 35 years (RR 3.73; p < 0.05), and average biopsy rejection score > 1 (RR 2.77; p < 0.05) as independent adverse predictors of cardiac events. In distinction, average daily cyclosporine dose > 4.5 mg/kg/day was found to confer a protective effect (RR 0.16; p = 0.03). CONCLUSIONS: The development of cardiac events as a result of cardiac allograft vasculopathy is influenced by the interdependence of allograft rejection and the balance of immunosuppression. The clinical implications of these findings point to the need for a reappraisal of our traditional approach to using corticosteroids (acute and maintenance) and cyclosporine (maintenance) in heart transplantation.

Adult↗