Common Finding In Subjects Research Articles

Abstract 13856: Echocardiographic Findings in Women With Ischemic Sudden Cardiac Death

Background: Majority of sudden cardiac deaths (SCD) are caused by coronary artery disease (CAD). Many women who experience SCD do not exhibit the traditional risk factors associated with SCD, which poses challenges in terms of SCD prevention and prediction. The data of SCD in women are limited as women are often underrepresented in SCD studies. Aim: The objective of this study was to investigate sex-specific echocardiographic findings in subjects with ischemic SCD. Methods: The study group consisted of 4392 subjects with ischemic SCD (20.2 % women) derived from the FinGesture study. The cause of death was determined at medicolegal autopsy. Pre-SCD echocardiography (ECHO) reports were collected from medical records. Ventricular and atrial dimensions as well as left ventricular mass (LVM) were categorized by using widely accepted thresholds. LVM was calculated using the LVM formula (LV Mass = (0.8 * [1.04 * ((LVEDD + IVSd + PWd) 3 - LVEDD 3 )]) + 0.6)). Left ventricular ejection fraction (LVEF) was classified into four categories: normal (>55 %), mildly reduced (45-55 %), moderately reduced (35-45 %) and severely reduced (<35 %). ECHO reports were available for 325 SCD victims (20.3 % women). Results: Left ventricular hypertrophy (LVH) was prevalent in 84.6 % of women and 76.4 % of men (p = 0.440). A thickened interventricular septum was observed in the majority of subjects in both sexes (84.8 % in women vs. 85.9 % in men, p = 1.000). Similarly, an enlarged left atrium was commonly found in both women (70.2 %) and men (72.3 %) (p = 0.856). The prevalence of dilated left ventricular end-diastolic diameter was 27.3 % in women and 30.1 % in men (p = 0.651). Overall, no significant differences were observed between the sexes in sex-adjusted ventricular or atrial dimensions. However, women with ischemic SCD were more likely to have a normal LVEF compared to men (63.4 % in women vs. 45.5 % in men, p <0.001). Additionally, the prevalence of severely reduced LVEF was significantly lower in women than in men (5.4 % in women vs. 15.9 % in men, p = 0.005). Conclusions: LVH is a common finding in subjects with ischemic SCD. Women with ischemic SCD are less likely than men to have severely reduced LVEF prior to SCD. Additionally, in women, ischemic SCD tends to occur more often without a decrease in LVEF.

Sex differences in prevalence of electrocardiographic and echocardiographic left ventricular hypertrophy among patients with coronary artery disease

Abstract Background Both electrocardiographic left ventricular hypertrophy (ECG-LVH) and echocardiographic LVH (echo-LVH) are associated with higher risk of cardiovascular and sudden cardiac death. ECG-LVH seems to be partly distinct from echo-LVH as many subjects with echo-LVH do not have ECG-LVH and vice versa. The difference between sexes have not been studied earlier. Purpose The aim of this study was to determine sex differences in prevalence of ECG-LVH and echo-LVH among patients with coronary artery disease (CAD) and to study if ECG-LVH would have higher accuracy for echo-LVH in either of sexes. Methods Standard 12-lead electrocardiograms and echocardiographic measurements were studied from 1,894 subjects of ARTEMIS Study (31.8% women). Echo-LVH was determined as estimated left ventricular (LV) mass ≥201 g in men and ≥151 g in women and was categorized as mildly, moderately and severely abnormal. ECG-LVH was determined if either criteria of Sokolow-Lyon or Cornell were met. Results Echo-LVH was found from 1,162 of the study subjects (women 34.3%, p=0.004) and ECG-LVH only from 222 of the subjects (women 55.9%, p<0.001). Of those with ECG-LVH, 82.0% had increased LV mass (p<0.001), and ECG-LVH seemed to correlate slightly better to echo-LVH in women than in men (82.3% vs. 81.6%, p<0.001). Of those with ECG-LVH, 47.7% had severe echo-LVH (p<0.001). The prevalence of ECG-LVH was the higher the greater the LV mass was. Among men with ECG-LVH, 46.9% had severe echo-LVH (p<0.001). Among women with ECG-LVH, 16.1% had mild echo-LVH (p=0.029) and 48.4% severe echo-LVH (p<0.001). In addition, 18% of those with ECG-LVH did not have echo-LVH (p<0.001). This proportion was slightly smaller in women than in men (17.7% vs. 18.4%, p<0.001). Only 15.7% of the subjects with echo-LVH had ECG-LVH (p<0.001). This proportion was significantly higher in women than in men (25.6% vs. 10.5%, p<0.001). ECG-LVH was more common finding in subjects with severe echo-LVH as 20.9% of those CAD patients had ECG-LVH (p<0.001). Among women with severe echo-LVH, ECG-LVH was found in 35.3% (p<0.001) whereas only in 13.7% of men with severe echo-LVH (p<0.001). The prevalence of ECG-LVH seemed to be considerably higher among female CAD patients with T2DM and without prior MI as ECG-LVH was seen in 33.0% of those subjects with at least midl echo-LVH (p<0.001) and 43.8% of those subjects with severe echo-LVH (p<0.001). In male patients from similar subgroup and some degree of echo-LVH, ECG-LVH was seen in 6.7% (p=0.042) and with severe echo-LVH in 12.2% (p<0.001) of the subjects. Conclusions In patients with CAD echo-LVH was often seen without signs of ECG-LVH, especially in men. Majority of the CAD patients with ECG-LVH had also echo-LVH and the prevalence on ECG-LVH was the higher the greater the LV mass was. ECG-LVH seemed to correlate better to anatomic LVH in women with CAD than in men, and the sex difference was highlighted in CAD patients with T2DM and no prior MI. Funding Acknowledgement Type of funding sources: None.

Visual word form processing deficits driven by severity of reading impairments in children with developmental dyslexia

The visual word form area (VWFA) in the left ventral occipito-temporal (vOT) cortex is key to fluent reading in children and adults. Diminished VWFA activation during print processing tasks is a common finding in subjects with severe reading problems. Here, we report fMRI data from a multicentre study with 140 children in primary school (7.9–12.2 years; 55 children with dyslexia, 73 typical readers, 12 intermediate readers). All performed a semantic task on visually presented words and a matched control task on symbol strings. With this large group of children, including the entire spectrum from severely impaired to highly fluent readers, we aimed to clarify the association of reading fluency and left vOT activation during visual word processing. The results of this study confirm reduced word-sensitive activation within the left vOT in children with dyslexia. Interestingly, the association of reading skills and left vOT activation was especially strong and spatially extended in children with dyslexia. Thus, deficits in basic visual word form processing increase with the severity of reading disability but seem only weakly associated with fluency within the typical reading range suggesting a linear dependence of reading scores with VFWA activation only in the poorest readers.

Efficacy and safety of high-dose intravenous iron as the first-choice therapy in outpatients with severe iron deficiency anemia.

Asymptomatic severe iron deficiency anemia is a common finding in subjects admitted to the outpatient anemia clinic. Although the condition can be easily be reversed with intravenous iron (IVI) therapy and several guidelines have suggested a restrictive threshold for using transfusion in hemodynamically stable patients, transfusion is often the rule in clinical practice. This study describes clinical practice results of IVI therapy without transfusion. In this multicenter retrospective observational study, data of severely anemic outpatients treated only with high-dose IVI with ferric carboxymaltose were collected. Inclusion criteria were hemoglobin (Hb) level of less than 7.0 g/dL and ferritin level of less than 30 ng/mL or mean corpuscular volume of less than 75 fL. Overall, 303 patients referred to the anemia clinic mainly from primary health care centers (46.2%) or the emergency department (28.7%) met the inclusion criteria. Median (interquartile range [IQR]) age was 47 (37-62) years and 84.5% were female. The median (IQR) Hb concentration at first visit was 6.5 (6.1-6.8) g/dL, 64 patients (21.1%) presented with a Hb level of less than 6.0 g/dL at diagnosis, and 11 of them (3.6%) had extreme anemia (Hb ≤ 5 g/dL). Gynecologic and gastroenteric bleeding were the main cause. After a mean IV administration of 1500 mg of iron, the Hb increased by a median of 5.7 g/dL. Thirteen patients experienced only mild side effects. In chronic very severe sideropenic anemias, third-generation IVI is effective and safe for quick correction and avoidance of red blood cell transfusion. These results suggest that more specific guidelines for this clinical setting are warranted.

Chronotype and Adherence to the Mediterranean Diet in Obesity: Results from the Opera Prevention Project.

Chronotype is the attitude of a subject in determining individual circadian preference in behavioral and biological rhythm relative to the external light–dark cycle. Obesity and unhealthy eating habits have been associated with evening chronotype. The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and quality of sleep. Thus, the aim of the study was to investigate the association of chronotype categories with adherence to the MD in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (obesity, programs of nutrition, education, research and assessment of the best treatment) Prevention Project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and chronotype were studied. Chronotype was classified as morning in 58.1% of subjects, evening in 12.8% and intermediate in 28.1%. Our results demonstrated that individuals with evening chronotype, when compared to intermediate (p < 0.001) and morning chronotype (p < 0.001), were more prone to follow unhealthy lifestyle, performing less regular activity and being more frequently smokers. In addition, they showed the lowest adherence to the MD compared to morning (p < 0.001) and intermediate chronotypes (p < 0.001). The lower the chronotype score, the higher body mass index (BMI) values in the whole population (r = −0.158; p = 0.038), thus suggesting that evening chronotype was a common finding in subjects with obesity. In addition, positive correlations of chronotype score with age (r = 0.159; p = 0.037) and PREDIMED score (r = 0.656; p < 0.001) were found. The adherence to the MD, more than the intake of the single food items, was found to predict morning and evening chronotypes. In conclusion, evening chronotype was associated with unhealthy lifestyle and low adherence to the MD. Chronotype score was inversely associated to BMI and positively associated to age and adherence to the MD. Thus, the assessment of chronotype should be taken into account in the management of obesity and in the development of nutritional strategies.

Natural evolution of popliteomeniscal fascicle tears over 2 years and its association with lateral articular knee cartilage degeneration in patients with traumatic anterior cruciate ligament tear.

To assess (i) normal imaging anatomy of the popliteomeniscal fascicles, (ii) prevalence and natural evolution of popliteomeniscal fascicle tears (PMFT) in subjects with traumatic anterior cruciate ligament (ACL) tears over 2 years and (iii) compare knee cartilage degeneration in subjects with and without PMFT longitudinally. 57 subjects with ACL tears were screened for PMFT. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MR imaging was performed prior to and 2 years after ACL reconstruction. Differences of morphological and compositional parameters were compared between subjects with and without PMFT using logistic regression, adjusting for age, sex and BMI. In 24% (n = 14) of the subjects with ACL tear a PMFT was detected on baseline MRI. One subject with PMFT developed a meniscal tear over 2 years. Cartilage ∆T1ρ of the lateral femur increased significantly more in subjects with isolated PMFT compared to controls (mean difference, 2.0 ± 2.9 vs. -1.3 ± 1.6, p = 0.027). PMFT detected by MRI are a common finding in subjects with ACL tears. Subjects with these defects showed higher compositional cartilage deterioration compared to controls, over 2 years in the lateral femoral compartment, indicating accelerated cartilage degeneration. • Popliteomeniscal fascicle lesions are a common finding in subjects with ACL tears. • Progression to a meniscal tear over 2 years is not frequent. • Anteroinferior popliteomeniscal fascicle is injured most frequently. • Patients with popliteomeniscal fascicle lesions showed accelerated cartilage degeneration.

Evolution of Intrameniscal Signal-Intensity Alterations Detected on MRI Over 24 Months in Patients With Traumatic Anterior Cruciate Ligament Tear.

The objective of our study was to assess the prevalence and evolution of intrameniscal signal-intensity alteration in subjects with an anterior cruciate ligament (ACL) tear over 24 months and compare clinical outcome and changes of cartilage between subjects with and those without this meniscal abnormality. Fifty-seven subjects with an ACL tear were screened for intrameniscal signal-intensity alteration. Morphologic and compositional MRI was performed before ACL reconstruction and 12 and 24 months after ACL reconstruction. Twelve subjects with an intrameniscal signal-intensity alteration and 12 subjects without any meniscal abnormality on MRI were identified. Clinical outcome was measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), and T1ρ and T2 maps of the cartilage were obtained. In 10 of 12 subjects (83%) the meniscal signal-intensity abnormality identified on baseline MRI was located at the posterior horn of the medial meniscus. None of these subjects presented with a meniscal tear over 24 months of follow-up. At 12 months after the ACL tear, the intrameniscal signal-intensity alteration detected on baseline MRI had completely resolved in seven of 12 subjects (58%), showed a signal-intensity decrease in four (33%), and remained stable in one subject (8%). Of the 10 subjects who underwent MRI at 24 months, the meniscal signal-intensity alteration had completely resolved in eight (80%), and the signal intensity had decreased in the other two subjects. Changes in the KOOS and cartilage T1ρ and T2 values from baseline and 24 months did not differ significantly between subjects with and those without intrameniscal signal-intensity alteration (p > 0.05). High intrameniscal signal-intensity alterations are a common finding in subjects with an ACL tear and have a benign course over 24 months after surgical repair of the ACL tear.

Impact of hyperuricaemia on the chronic kidney disease‐associated risk factors in a community‐based population

Hyperuricaemia is a common finding in subjects with lifestyle related diseases. This study was performed to examine its association with chronic kidney disease (CKD) in relation to other risk factors in a community-based population. Data from 187 914 participants, excepting CKD stage 5, of the health check-up were included in this analysis. The association between CKD and its risk factors were examined by a logistic analysis. The association of hyperuricaemia and CKD was also compared in the population without any lifestyle related diseases and the whole population. The prevalence of hyperuricaemia was significantly higher in the advanced stage of CKD. The odds ratio of hyperuricaemia was higher than that of other factors for the association with CKD. The odds ratio of many CKD-associated variables was increased in the advanced stage. Among them, the odds ratio of hyperuricaemia was markedly increased. The prevalence of hyperuricaemia was lower in the population without any lifestyle related diseases than in the whole population in the early stages, the difference of prevalence between the two populations becoming smaller in the advanced stage. The association of incident CKD with hyperuricaemia was stronger than with other chronic kidney disease-risk factors, this association becoming more significant in the advanced stage of chronic kidney disease. Although this result does not indicate the cause and result relationship, the data suggest that hyperuricaemia might not be appropriately treated in this population.

Prevalence of Thrombocytopenia in Egyptian Patients with Chronic Hepatitis C Virus

Thrombocytopenia is defined as a platelet count less than 150.000/mm3. It is a common finding in subjects with chronic hepatitis as HCV antibody-positive individuals are 2.6 times more likely to have a low platelet count than those who are HCV-antibody negative. However, controversy still exists concerning the mechanism of HCV-associated thrombocytopenia This work studied the thrombocytopenia prevalence in Egyptian patients with chronic HCV. Data of 100 patients with chronic hepatitis C presented to Tropical Medicine department, Al-Azhar University, included full history, clinical assessment, laboratory investigations (complete blood count, liver biochemical profile, kidney function tests and PCR), abdominal ultrasound and liver biopsy. The prevalence of thrombocytopenia among patients was 24/100 (24%), mild thrombocytopenia was the commonest grade (17%) then moderate one (6%) and lastly severe thrombocytopenia (1%). Thrombocytopenia significantly occurred more in older ages with high AST and ALT levels. The prevalence of thrombocytopenia significantly increased with abnormality liver Echopattern and with the progress of fibrosis and activity in liver biopsy.

Inter-relationships between platelet count, platelet IgG, serum IgG, immune complexes and severity of liver disease

Thrombocytopenia is a common finding in subjects with chronic liver diseases. A variety of mechanisms may underlie this. Immunological disturbances are commonly a feature in chronic liver disease, including hyperglobulinaemia and the presence of autoantibodies and circulating immune complexes and immune mechanisms could therefore contribute to thrombocytopenia. We have investigated the relationships between blood platelet count, serum IgG and IgG immune complexes and IgG associated with platelets in 92 subjects with chronic liver disease (27 with chronic active hepatitis, 38 with primary biliary cirrhosis and 27 with alcoholic liver disease). Severity of liver impairment was a major determinant of degree of thrombocytopenia. Also, an inverse relationship was demonstrated between platelet count and platelet-associated IgG. In subjects with chronic active hepatitis the relationships between platelet count, serum IgG immune complexes and platelet-associated IgG were consistent with a role for immune mechanisms in general and immune complexes in particular as mediators of the thrombocytopenia.

Intra day ECG variation after general anesthesia in Brugada syndrome

ECG variations of characteristic coved-type patterns are a common finding in subjects with Brugada syndrome. Few data are available about patients with Brugada syndrome undergoing major surgery and requiring general anesthesia. We reported ECG serial variations in a patient with Brugada syndrome who underwent surgery for tibial fracture. Relevant variations of ST patterns in V1-V2 leads over 24-h ECG monitoring were detectable, albeit these modifications were not associated with incidence of arrhythmias.

The good and the bad in the link between insulin resistance and vascular calcification

Medial arterial calcification is a common finding in subjects with diabetes mellitus. In vitro, glucose or insulin supplementations promote a phenotypic shift of smooth muscle cells into osteogenic cells, but the mechanisms driving this conversion are poorly understood. The binomial hyperglycaemia/hyperinsulinemia is typical of insulin resistance states, in which the metabolic and vasomotor (“good”) actions of insulin are selectively impaired, whereas its mitogenic (“bad”) signals are potently enhanced. Under these conditions, insulin can exert pro-atherosclerotic effects and promote vascular calcification. In this setting, the metabolic and mitogenic pathways may be not entirely antagonist, because they interact to traduce the normal insulin signal into inhibition of calcification. Emerging data suggest that the two pathways may converge on the regulation of phosphate transport and extracellular inorganic phosphate (Pi) concentrations. Two antagonist enzymes governing Pi metabolism are alkaline phosphatase (ALP) and the ectonucleotide pyrophosphatase/phosphodiesterase-1 (also known as PC-1): while ALP is up-regulated in calcified diabetic arteries, PC-1 is also implicated in the genesis of insulin resistance. Therefore, we suggest that the functional interactions between ALP and PC-1 may link insulin resistance to vascular calcification.

Hepatitis C virus-associated thrombocytopenia is not related to serum thrombopoietin levels

Hepatitis C virus (HCV) infection is one of the most important health problems in Egypt. Thrombocytopenia is a common finding in subjects with chronic hepatitis. The precise etiology of this thrombocytopenia is still obscure. There is increasing interest in the potential role of thrombopoietin (TPO) as a cause of this thrombocytopenia. The aim of this work was to determine serum TPO levels in HCV-positive patients and to test the assumption that HCV-associated thrombocytopenia could be due to low TPO levels. Forty patients with HCV infection were included in this study and classified into three groups according to the degree of thrombocytopenia (IA-mild, IB-moderate, II-none). Twenty five healthy volunteers served as control (Group III). All patients and controls had undergone full clinical assessment and the following laboratory investigations: complete blood count, liver function tests, prothrombin time and concentration and serum TPO level. TPO levels were significantly elevated in Group IA as compared to the control group ( P <0.05). No significant difference was found between groups IA and II. TPO in Group IB was slightly, but insignificantly reduced compared to Group IA but did not differ statistically from the control or Group II. Significant negative correlation was found between serum TPO levels and platelet counts in Groups IA, IB and II (r=-0.421, P <0.05). No correlations were found between serum TPO levels and liver function tests or hematological parameters. An impaired TPO production did not explain the development of thrombocytopenia in HCV and other mechanisms must be involved.

The Role of Prostacyclin and Thromboxane in Sepsis and Septic Shock

Prostacyclin, or prostaglandin I2 (PGI2), and thromboxane A2 (TXA2) are potent, endogenously produced, vasoactive substances that have been implicated as mediators in the pathophysiologic nature of septic shock. We investigated the contribution and production of PGI2 and TXA2 in sepsis and septic shock, using an intact rabbit model and an in vitro rabbit isolated cardiac perfusion model. Continuous hemodynamic monitoring of both experimental models, along with serial radioimmunoassays of the metabolites of PGI2 and TXA2, indicated that myocardial depression is a common finding in subjects with septic shock and that septic shock causes a suppression of PGI2 production while augmenting TXA2 production. In addition, PGI2 and TXA2 were mediators of some cardiovascular changes in septic shock but were themselves not the toxic factor(s) responsible for the associated myocardial depression.