Transthoracic (TTE) and transesophageal (TEE) echocardiographic studies with agitated saline, also known as "bubble studies" (BSs), are used to diagnose patent foramen ovales (PFOs) in cryptogenic strokes (CSs). Guidelines limit PFO closure recommendations to CS patients ≤ 60 but BSs are often performed as part of standard order sets, leading to inappropriate studies in older patients with already-established stroke etiologies.
Background: Abnormal P-wave terminal force in lead V1 (PTF-V1) is an ECG marker of increased left atrial (LA) volume, elevated LA filling pressures and/or LA systolic dysfunction. Because left ventricular (LV) diastolic dysfunction is one of the potential mechanisms driving LA remodelling, we hypothesized that PTF-V1 might be an additional ECG marker of diastolic dysfunction.Methods: LV diastolic function after 3 years' systematic antihypertensive treatment was examined in relation to baseline PTF-V1 in 431 hypertensive patients undergoing protocol-driven blood pressure reduction who had baseline and year-3 ECG and echocardiographic data and a preserved LV ejection fraction (EF >45%) at year-3. Abnormal diastolic function was defined by the tenth or 90th percentile values from 405 normotensive, non-obese and non-diabetic adults without overt cardiovascular disease. Abnormal PTF-V1, defined by the presence of a negative terminal P-wave in lead V1 ≥ 4000 μV·ms, was present in 167 patients (38.7%).Results: Abnormal PTF-V1 was associated with worse year-3 mean diastolic first third filling time (0.43 ± 0.08 vs 0.40 ± 0.07 sec, p = 0.039), first half filling time (0.55 ± 0.07 vs 0.53 ± 0.07 sec, p = 0.041), mitral valve A velocity (86 ± 27 vs 76 ± 19 cm/sec, p = 0.009) and mitral valve E/A ratio (0.85 ± 0.22 vs 0.94 ± 0.27, p = 0.007) after adjusting for other potential predictors of diastolic dysfunction including race, and heart rate, systolic blood pressure and severity of ECG LVH by Cornell product criteria at baseline. In parallel multivariate logistic regression analysis, abnormal PTF-V1 was associated with significantly increased odds of abnormal mitral valve E/A ratio (OR 1.55, 95%CI 1.04–2.32 p = 0.032), and a trend toward higher odds of abnormal half filling time (OR 1.42, 95%CI 0.94–2.15, p = 0.098) at year-3 of follow-up.Conclusions: Abnormal P-wave terminal force in lead V1 is associated with worse diastolic function and predicts abnormal LV diastolic behaviour in patients with preserved EF after 3 years of blood pressure reductive therapy.
Background: Persistence or development of Cornell product left ventricular hypertrophy (LVH) is associated with increased heart failure (HF) risk that is partly explained by greater LV systolic dysfunction. However, whether new or persistent Cornell product LVH during antihypertensive treatment is associated with worse LV diastolic function is unclear.Methods: Left ventricular diastolic function was examined in relation to year-3 ECG LVH in 377 hypertensive patients with a preserved LV ejection fraction (>45%) at year-3. Cornell product >2440 mm·ms defined ECG LVH.Results: In multivariate models adjusting for age, sex, change from baseline to year-3 systolic blood pressure, and baseline and change from baseline to year-3 Sokolow–Lyon voltage, persistent or new Cornell product LVH at year-3 remained associated with year-3 abnormal half filling time (OR 1.63, 95% CI 1.04–2.55 p = 0.034), with a trend toward higher odds of abnormal third filling time (OR 1.51, 95% CI 0.087 p = 0.087) and total filling time (OR 1.79, CI 0.98–3.27 p = 0.059).Conclusion: In hypertensive patients undergoing antihypertensive therapy, persistence or development of Cornell product ECG LVH at year-3 follow-up is modestly associated with LV diastolic dysfunction. These findings suggest that diastolic dysfunction may be a mechanism via which changing ECG LVH influences HF risk.
Twitter is a mobile social media microblogging service designed for instant online publication of short 280-character text-based messages known as tweets.Twitter's ability to rapidly circulate information and generate debate among its users has resulted in its application in arenas including politics, business, broadcasting, and academia.Fittingly, but not without controversy, Twitter use during major medical conferences has gained significant traction because of its ability to widely and rapidly disseminate information in real time 1,2 conferring a dramatic upside potential for medical education.Despite this rapid growth in social media utilization during major medical conferences, there is a paucity of data related to this in cardiology literature.This data report analyzes preliminary descriptive trends of Twitter use during 3 major cardiovascular meetings and evaluates its possible educational potential through a quantitative and qualitative analysis of conference-related tweets. METHODS AND RESULTSThe data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.Three annually occurring cardiovascular scientific sessions were chosen for analysis based on that meeting's acceptance and promotion of social media use during their respective meeting: The American College of Cardiology, Heart Rhythm Society, and Transcatheter Cardiovascular Therapeutics.Each conference had a predetermined official Twitter hashtag that was promoted before and during the meeting.Hashtags were registered with Symplur Signals, a healthcare social media analytics platform which curates all publicly posted data related to the official hashtag.Twitter activity from each scientific session from 2014 to 2016 was analyzed starting on 12:01 am of the first day of the conference through 11:59 pm of the conference end date.Tweet activity in the 3 days preceding and following conferences was not included as they represented an insignificant portion of the conference total.Data inclusion and analysis were adjusted based on the time zone of the city where the conference was held.Symplur Signals database was accessed to determine the total number of users, tweets, and impressions (tweets × number of followers).Users were categorized into professional groups including physician, other healthcare professional, patient/advocate, researcher/PhD, journalist/media, provider organization, government organization, pharma/industry, and unknown, based on information extracted from individual Twitter biographies.Qualitative tweet content analysis was performed manually for all tweets by 2 independent physicians to ensure internal reliability and was categorized as scientific (educational, related to meeting content), administrative (used to direct attendees to meeting sessions or locations), industry (related to product advertisement), social (references to conference unrelated to meeting content), or uninformative.Tweets were further categorized according to their country and continent of origin to assess their potential range and influence.Absolute values and percent change were determined to compare across years.
Following percutaneous coronary intervention (PCI), elevations in serum creatinine level and declines in glomerular filtration rate are common. Prior studies have demonstrated benefit of chronic statin therapy in the prevention of contrast-induced nephropathy (CIN); however, it is unknown whether chronic statin therapy reduces the incidence of CIN in the non-emergent PCI setting.Using the 2004-2005 Cornell Angioplasty Registry, a total of 1171 consecutive patients were selected for analysis. The population was divided into two groups: (1) patients on chronic (≥30 days) statin therapy prior to PCI (n = 874); and (2) patients not on chronic statin therapy (n = 297).Patients taking chronic statin therapy were more likely to have diabetes mellitus (35.7% vs 22.6%; P<.001), previous myocardial infarction (36.3% vs 20.5%; P<.001), previous PCI (38.9% vs 16.2%; P<.001), and previous coronary artery bypass graft surgery (19.5% vs 11.4%; P=.01). Statin users were also more likely to be taking long-term aspirin (77.8% vs 59.6%; P<.001) and clopidogrel therapy (29.9% vs 14.1%; P<.001). Baseline serum creatinine levels were comparable between the two groups, as were procedural characteristics. The incidence of CIN following PCI was not significantly different between patients on chronic statin therapy versus those not on chronic statin therapy (4.2% vs 5.4%; P=.42). However, after multivariate adjustment, chronic statin therapy was associated with a lower incidence of CIN (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.05-0.94; P=.04). Acute heart failure on admission and the urgency of the procedure (urgent vs elective PCI) were also independent predictors for developing CIN (OR, 3.04; 95% CI, 1.45-6.66 [P=.01] and OR, 2.80; 95% CI, 1.42-5.55 [P=.01], respectively). Long-term mortality rates were similar between those on chronic statin therapy and those not on statins.CIN occurred in 4.5% of patients following non-emergent PCI. Multivariate analysis demonstrated that chronic statin therapy decreased the odds of developing CIN in patients undergoing PCI.
