Diagnostic Utility of Comprehensive Balance Function Testing in Patients with Vertigo and the Role of Database Development for Future AI Integration

One of the main complications of multiple sclerosis (MS) is imbalance and walking problems that can lead to falls. This study investigated the association between a fall measurement scale called the Hopkins Falls Grading Scale (HFGS) and motor function tests in patients with MS. This cross sectional study was conducted using convenience sampling on 85 patients referred to the MS Association of Mashhad, Iran, in 2023. The HFGS examined falls during the past year and divided them into 4 degrees, and the function test included the timed 25 foot walk (T25FW) test and the timed up and go (TUG) test. Kruskal-Wallis test and Spearman's correlation coefficient were used for data analysis. A statistically significant association was obtained between HFGS and functional tests (T25FW and TUG) (for both P < 0.0001). A significant association was observed between the variables of age (P = 0.006), duration of the disease (P = 0.03), the use of mobility devices (P = 0.05), and HFGS. Considering the association between HFGS and motor function tests in MS patients, clinical experts should pay attention to patients who have slower movement and evaluate them in terms of falling status when performing motor function tests.

There is little published evidence regarding the extent to which renal function testing is performed in older Australians, particularly those with dementia. To examine the prevalence and temporal trends in renal function testing and the factors associated with renal function testing in patients with dementia using Australian general practice data. Ten consecutive cross-sectional analyses were performed to evaluate the proportion of patients aged ≥ 65years with a recorded diagnosis of dementia, along with matched controls, who had renal function tests using estimated glomerular filtration rate (eGFR) within the twelve months of each year from 2011 to 2020. Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. Over the study period, renal function testing increased in both groups, although less for the patients with dementia; from 38.6% (95% CI 37.1-40.0%) in 2011 to 41.9% (95% CI 41-42.9%; p for trend < 0.001) in 2020 in the dementia group, and 49% (95% CI 47.6-50.5%) to 60.4% (95% CI 59.5-61.4%; p for trend < 0.001) in the matched controls. Younger patients with dementia (< 85years of age), males, and those with more general practitioner visits in the preceding 12months, hypertension, diabetes, chronic kidney disease, osteoporosis, or pain were most likely to have renal function testing. Rates of renal function testing in primary care patients with dementia in Australia were significantly lower than for matched controls, and improved only marginally between 2011 and 2020.

HomeCirculationVol. 136, No. 22Letter by Jin-shan and Xue-bin Regarding Article, “Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Jin-shan and Xue-bin Regarding Article, “Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)” He Jin-shan, MD and Li Xue-bin, MD He Jin-shanHe Jin-shan Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author and Li Xue-binLi Xue-bin Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author Originally published28 Nov 2017https://doi.org/10.1161/CIRCULATIONAHA.117.030674Circulation. 2017;136:2202–2203To the Editor:We read with great interest the article by Hoffmann and colleagues1 about the prognostic value of noninvasive cardiovascular testing in patients with stable chest pain. The article indicates that coronary computed tomography angiography (CTA) provides better prognostic information than functional testing in contemporary patients who have stable chest pain with a low burden of obstructive coronary artery disease, myocardial ischemia, and events. CTA operates by identifying patients at risk for nonobstructive coronary artery disease. This article is a randomized comparison of the ability of anatomic and functional testing to correctly classify risk in symptomatic patients and will have a large influence on the management of patients with stable chest pain.We have 3 suggestions. First, coronary atherosclerosis causing between 1% and 69% luminal narrowing has emerged as a significant and frequent finding that, although often not associated with myocardial ischemia, carries a substantial risk for major adverse cardiovascular events in comparison with patients without any coronary artery disease.2 CTA can visualize minimal nonobstructive coronary artery disease, even the plaques, and it can tell which kind of plaque is a high risk for causing clinical events. The coronary artery system has great compensation ability, and the functional test will be abnormal when the stenosis is severe and normal if not. CTA identifies additional at-risk patients and imparts better prognostic and discriminatory information than functional testing. Second, because CTA is preferable to functional testing in patients with stable chest pain, it should be used widely in clinical practice. Two areas of concern include allergy to the contrast agent and the x-ray dose. We need to improve the techniques to lower the x-ray dose and rate of allergy to the contrast agent. Third, functional testing provides better prognostic information in high-risk patients with severe stenosis, but during the testing, myocardial ischemia may be induced and leads to myocardial infarction for these patients. Considering both efficacy and safety, CTA is more suitable when managing patients with stable chest pain.He Jin-shan, MDLi Xue-bin, MDDisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.

Background. Type 2 diabetes mellitus (T2DM) is a common metabolic disease associated with pathophysiological changes in the neuromuscular system. The present study aimed to investigate the effects of a 6-week endurance training program on muscle strength, electrophysiological parameters, and functional activities in T2DM patients. Methods. The study period was divided into 6 weeks without training and 6 weeks with training. Twelve T2DM patients participated in this study. During the training period, the same T2DM patients went through an endurance training program. The assessment process included measurement of muscle strength, surface electromyography (SEMG) recording, and functional tests. Twelve healthy individuals were evaluated to compare their data with the T2DM patients. Results. The results showed that the muscle strength and the amplitudes of the SEMG signals of T2DM patients were lower than those of the healthy subjects. The bioelectric activity of T2DM patients increased after six weeks of the endurance training program. The functional tests showed significant improvement after the endurance training program in T2DM patients, while no significant difference was observed between the T2DM and healthy subjects. Conclusions. The short-term endurance-training program for lower limb muscles increased muscle strength and SEMG amplitudes of the knee extensor and flexor muscles and improved functional tests in T2DM patients, which may be attributed to neural adaptation after the endurance-training program.

BackgroundPlatelet function testing is controversial and not well studied in patients with neurovascular disease.ObjectiveTo evaluate the performance of thromboelastography (TEG) as a platelet function test in neurovascular patients treated with...

Objectives: The aim of the present study was to investigate autonomic regulation at rest and in response to functional laboratory tests in patients with chronic low back pain [CLBP], as well as its ...

IntroductionIntroduction The role of platelet function testing in patients with intracranial aneurysms undergoing flow diversion remains controversial with limited evidence of its influence on thrombotic outcomes. We report an observational cohort analysis evaluating the association of P2Y12 assay testing with thrombotic events in patients undergoing flow diversion.MethodsWe performed a retrospective review of our prospectively maintained procedural database to identify patients who underwent flow diversion between January 2020 and July 2022. One physician within our practice never performs P2Y12 assay testing. All other physicians utilize P2Y12 assay testing as part of routine practice. These two different patient cohorts were compared. Acute thrombotic events were our primary outcome. Secondary outcomes included delayed intracerebral hemorrhage, intimal hyperplasia without clinical sequalae, and transient neurologic deficits.ResultsWe identified 150 patients who underwent flow diversion at our institution between January 2020 and July 2022. Median age was 59 years old (Interquartile range (IQR) 49–67), with 113 females (82.5%) and 24 males (17.5%). Out of 150 patients, 93 (62.0%) patients were treated by physicians who performed routine pre and postoperative testing of aspirin and Plavix assays, with subsequent adjustment of antithrombotic dosing accordingly, while 57 patients (38.0%) were treated by the single physician who prescribes aspirin and clopidogrel pre‐operatively without testing. In all, seven out of 150 patients (4.7%) had an acute thrombotic event requiring intraarterial anti‐thrombotic infusion or urgent thrombectomy, or both. Of these, six where from the 93 patient testing cohort (6.5%), and one in 57 patients non‐testing cohort (1.8%) (p = 0.2). Patients who had a thrombotic event were more likely to have underlying atrial fibrillation (28.6% vs 4.9%, p = 0.01) but otherwise had similar demographics, vascular risk factors, maximal aneurysmal diameter, and parent vessel diameter (Table 1). In a multivariable analysis adjusting for age, maximal aneurysm diameter, ruptured aneurysms, and atrial fibrillation, P2Y12 sensitivity assay testing was not significantly associated with acute thrombotic events in aneurysm patients undergoing flow diversion (Odds Ratio (OR) = 0.15, 95% Confidence Interval (CI) = 0.01‐2.67), p = 0.2). Secondary outcomes were also comparable between both groups; transient neurologic deficits were noted in 4/93 in the testing group (4.3%), and 6/57 in the non‐testing group (10%) (p = 0.14), intracranial hemorrhage occurred in only 2 patients, both in the testing group (p = 0.3), and mild intimal hyperplasia was observed in 18.3% in the testing group versus 12.3% in the non‐testing group (p = 0.33).ConclusionsPlatelet function testing showed no significant correlation with thrombotic events or outcomes in our cohort. The role of platelet function testing remains controversial, albeit widely used in patients undergoing flow diversion of intracranial aneurysms.

Coronary artery disease (CAD) is a common finding in patients suffering from aortic valve stenosis (AS), with a prevalence of over 50% in patients 70 years of age or older. Transcatheter aortic valve intervention (TAVI) is the standard treatment option for patients with severe AS and at least 75 years of age. Current guidelines recommend percutaneous coronary intervention (PCI) in patients planned for TAVI with stenoses of >70% in the proximal segments of non-left main coronary arteries and in >50% of left main stenoses. While the guidelines on myocardial revascularization clearly recommend functional assessment of coronary artery stenoses of less than 90% in the absence of non-invasive ischemia testing, a statement regarding invasive functional testing in AS patients with concomitant CAD is lacking in the recently published guideline on the management of valvular heart disease. This review aims to provide an overview of the hemodynamic background in AS patients, discusses and summarizes the current evidence of invasive functional testing in patients with severe AS, and gives a future perspective on the ongoing trials on that topic.

The use of platelet function testing in PCI and CABG patients

Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes. To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG. Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry. In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk. In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate.

Background: The possibility of myocardial bridging (MB) causing chest pain has been widely reported; however, the effect of MB on coronary microvessels has not been thoroughly investigated. Therefore, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function during coronary angiography (CAG) and coronary function test (CFT) in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Methods: This study included 62 patients with INOCA who underwent CAG and CFT for the left anterior descending coronary artery (LAD) to evaluate chest pain. In the CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic ST-T changes and CAG. Positive coronary spasm was defined as coronary vasoconstriction of >90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. After nitroglycerin administration, CAG was performed to assess MB, which was defined as systolic narrowing of the coronary artery diameter by >20% compared with that in diastole. Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were subsequently obtained via transvenous adenosine triphosphate infusion using a pressure wire. Coronary microvascular vasodilatory dysfunction (CMD) was defined as a CFR of <2.0 or an IMR of ≥25 units. Results: Of the 62 patients, 15 (24%) had MB. The patients’ characteristics did not differ between the two groups. Regarding the CAG and CFT results, the presence of coronary spasm in the LAD was higher in the MB (+) group (87%) than in the MB (−) group (53%, p = 0.02), whereas the values of CFR (MB (+): 2.7 ± 1.4, MB (−): 2.8 ± 1.1) and IMR (MB (+): 26.9 ± 1.0, MB (−): 30.0 ± 17.3) and the presence of CMD (MB (+): 53%, MB (−): 60%) were similar in the two groups. Conclusions: The findings suggest that MB predisposes patients with INOCA to coronary spasms. Conversely, MBs may have a limited effect on microvessels, particularly in such patients.

Introduction: The possibility of myocardial bridge (MB) causing chest pain has been widely reported; however, the effect of MBs on coronary microvessels has not been thoroughly investigated. Hypothesis: Thus, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function during coronary angiography (CAG) and coronary function tests (CFT) in patients with ischemia with non-obstructive coronary arteries (INOCA). Methods: This study included 57 patients with INOCA who underwent CAG and CFT to evaluate chest pain. In CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic changes [Editor1] and CAG. Positive coronary spasm was defined as coronary vasoconstriction of &gt;90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. After nitroglycerin administration, CAG was performed to assess MB, which is defined as the systolic narrowing of the coronary artery diameter by &gt;20% compared to that in diastole. Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were subsequently obtained by transvenous adenosine triphosphate infusion using a pressure wire. Coronary microvascular vasodilatory dysfunction (CMD) was defined as CFR of &lt;2.0 or IMR of ≥25 units. Results: Of the 57 patients, 13 (23%) had MB. The CAG and coronary CFT results in the MB (+) and MB (–) groups are shown below. Conclusions: These findings suggest that MB predisposes to coronary spasms in patients with INOCA. Conversely, MBs may have a limited effect on microvessels, particularly in such patients.

Pulmonary function testing (PFT) in patients with tracheostomies has been perceived as difficult to perform and clinically unreliable. We studied the feasibility, quality, repeatability and clinical significance of PFT. Patients with tracheostomies that underwent PFT from January 1, 2010 to February 29, 2012 were identified. Clinical history and PFT data were reviewed retrospectively. Fifty patients (88% men) were identified. Forty-seven (94%) patients were able to perform PFT. Acceptable repeatability was obtained for FVC in 39 (83%) and for FEV1 in 41 (87%). Patients with tracheostomies showed difficulty in meeting ATS end-of-test criteria; only 9 (19%) met plateau criteria and 25 (53%) had exhalation times of greater than 6s. Obstructive pattern was observed in 30 (64%) and restrictive pattern in 9 (19%). DLCO measurements were attempted in 43 patients and satisfactorily obtained in 34 (79%). PFT can be performed with reliability in patients with tracheostomies, and they are useful for detecting and classifying types of lung dysfunction.

Coronary function testing in patients with ischemia and nonobstructive coronary arteries (INOCA) commonly includes assessment of adenosine-mediated vasodilation and acetylcholine spasm provocation. The purpose of this study was to evaluate the diagnostic value of additional endothelial function testing for the diagnosis of vasomotor dysfunction in patients with INOCA. In this retrospective cohort study, we included patients with INOCA who underwent clinically indicated comprehensive coronary function testing. Endothelial dysfunction was defined as a <50% increase in coronary blood flow, determined by Doppler flow, and/or epicardial vasoconstriction compared to baseline, in response to low-dose acetylcholine. Coronary artery spasm (CAS) was defined as vasospastic angina or microvascular angina in response to coronary high-dose acetylcholine. An impaired adenosine-mediated vasodilation was defined as a coronary flow reserve <2.5 and/or hyperemic microvascular resistance ≥2.5. Among all 110 patients, 79% had endothelial dysfunction, 62% had CAS, and 29% had an impaired adenosine-mediated vasodilation. Endothelial dysfunction was present in 80% of patients who tested positively for CAS and/or an impaired adenosine-mediated vasodilation. Endothelial function testing increases the diagnostic yield of coronary function testing that only incorporates adenosine testing and spasm provocation by 17% to 92%. Of patients with normal adenosine-mediated vasodilation and no inducible CAS, 68% had endothelial dysfunction. Concomitant endothelial dysfunction was prevalent in the vast majority of patients with INOCA with inducible CAS and/or an impaired adenosine-mediated vasodilation. In patients with INOCA without inducible CAS and normal adenosine-mediated vasodilation, two-thirds had endothelial dysfunction. These results indicate the relevance to perform endothelial function testing in patients with INOCA in view of its therapeutic implication.

HomeCirculation: Cardiovascular InterventionsVol. 3, No. 4Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published1 Aug 2010https://doi.org/10.1161/HCV.0b013e3181efe035Circulation: Cardiovascular Interventions. 2010;3:e18This article corrects the followingThe Evidence Base for Platelet Function Testing in Patients Undergoing Percutaneous Coronary InterventionIn the article, “The Evidence Base for Platelet Function Testing in Patients Undergoing Percutaneous Coronary Intervention, “ by Matthew J. Price, which appeared in the June 2010 issue of the journal (Circulation: Cardiovascular Interventions. 2010;3:277–283), there was an error in Table 2.In Table 2 on page 280, for the column reading “Duration,” it should be noted that the values are given in months (mo), not in minutes (min) as shown.The online version of this article has been corrected. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesThe Evidence Base for Platelet Function Testing in Patients Undergoing Percutaneous Coronary InterventionMatthew J. Price,Circulation: Cardiovascular Interventions. 2010;3:277-283 August 2010Vol 3, Issue 4 Advertisement Article InformationMetrics © 2010 American Heart Association, Inc.https://doi.org/10.1161/HCV.0b013e3181efe035 Originally publishedAugust 1, 2010 PDF download Advertisement