Normal Chest Research Articles

Heat shock protein-90

Background It has recently been shown that the heat shock protein (HSP) is implicated in the pathogenesis of pulmonary fibrosis. The current trial was achieved to detect the relation of HSP-90 in usual interstitial pneumonia (UIP)-associated rheumatoid arthritis (RA). Results Sixty RA patients were studied. Their mean age was 49.63 ± 9.22 years with a mean disease duration of 7.5 (2–14) years. High-resolution computed tomography (HRCT) chest was performed on all patients. Thirty four (56.6%) patients had abnormal radiological findings in CT chest and 26 (43.3%) had normal CT chest findings. In patients with pulmonary involvement by HRCT, the most common abnormality found was small airway disease in 23 (38.3%), followed by UIP in nine (15%), and rheumatoid nodules in two (3.3%) patients. Patients with UIP pattern in HRCT chest has a significant higher level of HSP-90 level in comparison with those with RA-associated small airway disease pattern, P=0.003, and in comparison with other RA patients with no pulmonary involvement by HRCT, P=0.006. Conclusions HSP-90 was significantly elevated in UIP-associated RA and hence studying its inhibition in further studies would have a promising therapeutic role in this subset of patients.

S3034 Histoplasmosis Infection Presented as Cholestatic Liver Disease

Introduction: Histoplasmosis is the most common mycosis in the United States with peak incidence in the Midwest region. In ∼21% of patients with systemic histoplasmosis hyperbilirubinemia can be detected. However, cholestatic presentation of histoplasmosis infection is very rare. Here we present a case of immunocompromised patient with predominant cholestatic liver disease caused by Histoplasma Capsulatum. Case Description/Methods: This is the case of 56- years- old female who presented with– sided abdominal pain, shortness of breath, chills, hot flushes, nausea, vomiting and diarrhea. She is suffering from rheumatoid arthritis. Her medications are adalimumab, celecoxib, hydroxychloroquine. She denied alcohol intake. Her initial workup including liver function tests (LFTs) was positive for a total bilirubin 3.5 mg/dl, conjugated bilirubin 2.7 mg/dl, alkaline phosphatase – 547 U/L, AST – 152 U/L, ALT-142 U/L, and platelet count – 55 k/ul. During hospitalization her abdominal pain was getting progressively worse, and her LFTs continued to trend up. Eventually liver biopsy was performed. The results showed multiple granulomas with central necrosis, and associated portal and lobular inflammation. The fungal stain highlighted yeasts suggestive of histoplasma. Her urinary histoplasma Ag Quantitative EIA eventually came back positive -8.87 ng/ml. Viewing the normal chest x-ray and ongoing hypoxia, chest CT scan with IV contrast was performed showing 1.1 cm lung nodule in the left lower lobe. A subsequent bronchoscopy revealed budding yeasts. Patient was started on liposomal amphotericin B, and her LFTs trended down. The patient was treated with amphotericin B for 21days subsequently changed to twice-daily oral Itraconazole 200mg. At the outpatient follow up visit, patient admitted a complete resolution of her abdominal pain and improvement of her breathing status. Discussion: Liver histoplasmosis is a rare cause for cholestatic liver disease. Over the past two decades, a limited number of cases with similar clinical scenario were described. Despite of the rarity of this condition, hepatic histoplasmosis should be considered in a selected population of immunocompromised patients living in an endemic area (ex: Ohio). Inclusion of urine antigen testing for histoplasma in early workup can potentially prevent diagnostic delay.

ABCL-031 Demographics and Outcome of Diffuse Large B-Cell Lymphoma Patients in Iraq-Kurdistan-Slemani City

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous form of hematological malignancy that comprises about 30% of lymphomas with variable outcomes. Onset is usually in the sixth decade of life with male predominance. Morphological, clinical, and biological variation of DLBCL confirms the coexistence of several subtypes of the disease with distinct behavior of each type. The aims of this study were to determine the demographics and outcome of patients with DLBCL and compare these parameters with regional and international data. A retrospective study was conducted on 61 patients with confirmed diagnosis of DLBCL. The diagnosis was based on histopathological and immunohistochemistry which was done in the Department of Pathology, Shorsh General Hospital in Sulaimani. The cases were randomly selected according to the availability of data from March 2013-March 2017. Median age at diagnosis was about 51 years with the peak age of incidence between 50 and 64 years, with female predominance. The most common site of the primary tumor was nodal in which the cervical lymph node is the most common site, and the majority of patients were in Stage III with predominance of B-symptoms. The vast majority of the patients have normal chest X-ray, and majority of the patients were in remission over a period of 19 months of follow-up. We found that there is a significant relationship between age, stage, and performance of the patients, while no significant relation between other parameters and the outcome of the patients is near to their Peers internationally.

POST-COVID PULMONARY COMPLICATIONS IN THE OUTPATIENT SETTING: ARE WE PREPARED FOR THE AVALANCHE?

POST-COVID PULMONARY COMPLICATIONS IN THE OUTPATIENT SETTING: ARE WE PREPARED FOR THE AVALANCHE?

The frequency of cardiovascular complications in patients suffering from COVID-19

Background: Pandemic caused by Corona virus infection has damaged the population throughout the universe. Cases of COVID-19 increased rapidly in whole world. COVID-19 has been associated with a number of cardiovascular co-morbidities including hypertension, ischemic heart disease, diabetes mellitus, dyslipidemia, atrial fibrillation and cardiac failure.
 Aims and objective: To determine the frequency of cardiovascular complications in patients with COVID-19.
 Material and methods: This observational cohort study was conducted in corona ward of DHQ Hospital, Gujrat from 1st January to 31st June 2021. Total 216 patients between 18-70 years of age, admitted who had COVID-19 confirmed by PCR after taking informed consent; patients already suffering from any cardiovascular, respiratory or other life threatening illness were excluded while hypertensive, diabetics and smoker were included in the study. Duration of admission was according to the severity of illness. Detailed history was taken from all patients followed by relevant examination. Investigations like ECG, echocardiographically and troponins were done to diagnose cardiovascular complications. All the patients were treated conservatively. Frequency of cardiovascular complications was noted. The patients who had clinical relief of symptoms, fever free, normal X-Ray chest and at least two consecutive negative PCR results for covid-19 were discharged. p value <0.05 was considered as significant.
 Results:� Out of two hundred sixteen patients, 30(14%) patients were diabetics and 21(10%) were hypertensive. Myocardial injury in 12% (myocarditis 4%, myocardial infarction 1%, raised troponins without myocarditis and ECG changes in 7% thromboembolism 1%, right ventricle dysfunction 5%, arrhythmias in 9%. Most of the patients had mild symptoms and recovered by conservative management. About 4-5% patients required invasive ventilatory support. Age, gender, diabetes, hypertension and previous cardiovascular co-morbidities increase the frequency of cardiovascular complications. Overall mortality was around 2%. p value was calculated as significant < 0.05.
 Conclusion: COVID-19 is known for cardiovascular complications in which acute myocardial injury, myocarditis, arrhythmias, thromboembolism, right ventricle dysfunction are common. These complications are more common in those having cardiovascular disease (CVD) or other co-morbidities

Teknik Segmentasi untuk Mengidentifikasi Kelainan Jantung pada Citra Rontgen Dada

The annual death toll from heart disease is 17.5 million people. Currently, heart disease is a prevalent condition that kills a lot of people and shortens people's lives. Life is based on the work of the heart, since the heart is a much-needed part of our body where life is impossible. Heart disease affects heart function and can lead to death or annoy the patient before deathThe use of contemporary medical imaging methods like computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI), as well as X-rays, is now commonplace. These methods enable non-invasive qualitative and quantitative assessment of the anatomical structure and function of the heart and support diagnosis, disease monitoring, treatment planning, and prognosis. The purpose of this study is to find heart problems in patients. The data used in this study were chest X-rays of patients with normal heart conditions and chest X-rays of abnormal heart patients obtained from the kaggle website. Segmentation techniques are used to process these cardiac images. Segmentation is the process of separating between an object and another object or between objects and the background contained in an image. Then the calculation of the area of the heart area is carried out using the extraction of morpological and regional features method characteristics with an algorithm that has been developed. The results of this study can identify heart defects through the process of measuring the area of the heart normal and abnormal. So that it produces a good accuracy rate of 85%. This segmentation technique is proven to be very good so that it can be a medical reference to perform further medical actions against abnormalities in the heart.

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

P45 Lyme-associated uveitis: Panuveitis and positive Lyme results – is it a masquerade or the real deal?

P46 A rare case of costovertebral arthritis in SLE

P46 A rare case of costovertebral arthritis in SLE

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

Clinical Profile of Children Hospitalized with COVID-19 in Indonesia’s District Hospital : A First Year Pandemic Wave Single Centre Study

<p><strong>Background:</strong><strong> </strong>Children are known to be less infected by Coronavirus disease 2019 (COVID-19) rather than adults. However, children are still a vulnerable group and the incidence of patients admitted to hospital continues to increase. As Indonesia’s district has limited resources during pandemic wave, the data on pandemic cases was still underreported especially cases of children.</p><p><strong>Methods:</strong> This retrospective observational study collected data on pediatric case aged 0 – 18 years old, who were hospitalized at dr. Soebandi Hospital, Jember, Indonesia and confirmed to have COVID-19, from March 2020 to the end of March 2021.</p><p><strong>Results:</strong><strong> </strong>40 children were hospitalized and confirmed COVID-19 during the study period, the majority aged 15 – 18 years (40%), male (65%), and had a history of contact (67.5%). The most common symptoms were cough (85%), fever (67.5%), and shortness of breath (40%). Laboratory results showed that the majority had decreased neutrophils and increased lymphocytes, while most of the patient had normal chest X-rays (52.5%). From 5 pediatric patients who had multimorbidity, 4 patients died. All four had common underweight clinical morbidity, while acute respiratory distress syndrome was dominated the cause of death. The mortality rate in this study reached 10%.</p><p><strong>Conclusion:</strong><strong> </strong>The majority of pediatric patients were found to have mild to moderate symptoms with good outcomes. Case mortality rate in this study was lower than national data. Meanwhile, the underweight comorbid in children with COVID-19 was worsening the outcome in this study.</p>

Chest CT findings in COVID 19 disease in relation with duration of illness: A study of two hundred cases.

Chest CT scans of 200 symptomatic patients infected with COVID 19 from different health facilities and home were reviewed for common CT findings in relationship with their clinical symptoms, comorbidities and the time between symptom onset and the initial CT scan was studied in this cross-sectional study. Cases were categorized into three groups according to the timing of HRCT, 10 cases were in early (0-2days), 56 cases in intermediate (3-5days) and 110 cases were in late (6-12days) groups. Chest CT scan images showed bilateral peripheral ground glass opacities 96.63%, pulmonary consolidations 15.9%. Notably 29.54% patient had normal CT scan chest and 60% of them were imaged at early phase. With a longer duration of symptoms, chest CT findings were more typical including GGO, consolidation with greater total lung involvement. Bilateral peripheral GGO was observed in 20% patients at early phase while 53.57% and 64.54% were observed at intermediate and late phase of illness. Among the symptoms cough and dyspnea were observed more related with typical CT changes (95%). Diabetes and Hypertension (58% of patients) were the leading comorbidities that were found related with GGO and other typical CT findings. Mean time duration between symptom onset and positive RT PCR, CT scan changes were 4.79 and 7.55 respectively.
 Central Medical College Journal Vol 5 No 2 Jul 2021 PP 70-75

The Relationship of Risk Factors and Comorbidity with Chest Radiography Features of COVID-19 Confirmed Patients

Introduction: COVID-19 is a worldwide health problem with a high mortality rate, especially in patients with risk factors. One type of examination to inspect the severity of COVID-19 patients is a chest radiograph. There is a lack of studies on chest radiography features in Indonesia. This study aims to observe the relationship between age, gender, and comorbid conditions with chest radiography features in COVID-19 confirmed.Method: This study was conducted at dr. Soebandi General Hospital uses a cross-sectional design with medical records as the instrument. Chest radiography examination was performed using BSTI classification. Meanwhile, data were analyzed using Chi-Square and contingency coefficient C.Result: The study included 173 patients: 52% were 40-59 years old, 36,4% were 20-39 years old, and 11,6% were ≥ 60 years old; 56,1% were female and 53,9% were male; 50,9% have comorbidities, with hypertension, diabetes, and COPD were the most type of comorbidities. About 48,6% sample had a normal chest radiograph, 27,7% had a mild severity, 17,3% had a moderate severity, and 6,4% had a severe severity. There was a correlation between age and comorbidity with chest radiography features. Otherwise, no correlation was found between sex and chest radiography features.Conclusion: Age and comorbidity were found as significant risk factors for the severity of chest radiograph in COVID-19 with a moderate correlation. However, no correlation was found between sex and chest radiography features.

A Clinical Profile of Pediatric COVID-19 Testing in the Emergency Department, Dubai, United Arab Emirates.

Background The COVID-19 pandemic marked a health and economic crisis of massive proportions. In its early months, literature was centered on adult medical and critical care. As time progressed, international reports of COVID-19 infection in children steadily grew; however, data on disease features in the United Arab Emirates' pediatric population was noticeably lagging. Method The presented research was conducted at Latifa Women and Children Hospital Emergency Department to ascertain an association between a child's presenting features and basic investigations to a subsequent positive COVID-19 test result. Data was collected via electronic medical records and statistical analysis performed with SPSS version 22.0. Results A total of four hundred and five (405) patients were analyzed, with 32 (8%) being COVID-19 positive on initial testing in emergency department. There is a statistically significant correlation (p < 0.05) between testing positive for COVID-19 infection and history of exposure to COVID-19-positive individuals; the presence of runny nose, cough, poor feeding, and abdominal pain with reassuring physical examination findings; and predominantly normal reports of basic blood investigations and chest X-ray images. Conclusion This research demonstrates that a minority of children tested for COVID-19 in the initial wave of the pandemic tested positive. A significant proportion of COVID-19-positive pediatric patients exhibit history of exposure to COVID-19-positive individuals; the presence of runny nose, cough, poor feeding, and abdominal pain; normal physical examination; normal basic blood investigations and chest X-ray findings.

Publication timeline of chest imaging reporting in children with coronavirus disease 2019 (COVID-19): a systematic review spanning 2020.

Amid the coronavirus disease 2019 (COVID-19) pandemic, numerous publications of imaging findings in children have surfaced in a very short time. Publications discuss populations of overlapping age groups and describe different imaging patterns. We aim to present an overview of the quantity and type of literature available regarding COVID-19 chest imaging findings in children according to a 2020 publication timeline. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched terminology related to COVID-19, chest, children and imaging modalities in PubMed and Embase. The included papers were published online in 2020 and described imaging findings specific to children and reported five or more cases. Two researchers reviewed each abstract to determine inclusion or exclusion, and a radiologist reconciled any disagreements. Then we reviewed full articles for the main analysis. Eligible study designs included original articles, case series (≥5 cases), systematic reviews and meta-analyses. We excluded non-English manuscripts, retracted articles, and those without available full text. The remaining articles were distributed to four pediatric radiologists (on the Society for Pediatric Radiology Thoracic Committee), who summarized chest imaging findings. Eighty-two articles were included in the final analysis — 28% in radiology journals and 71% in non-radiology journals; 71% contained original data and 29% were review-style papers. There was a disproportionate contribution of review-style papers in April (55%), considering the paucity of preceding publications with original data in March (5 papers). June had the highest number of publications (n=14), followed by April (n=11) and July (n=11). Most (52%) original papers were from China and most individual pediatric imaging descriptions were from China (57%), while the majority of review papers (83%) were international. Imaging descriptions were available for 2,199 children (1,678 CT descriptions and 780 chest radiography descriptions). Findings included a 25% normal CT scan reports vs. 40% normal chest radiography reports. Ground-glass opacification was the most common CT finding (33%) and was reported in only a minority of chest radiographs (9%). A significant amount of information on pediatric COVID-19 chest imaging has become rapidly available over a short period. Most publications in 2020 were original articles, but they were published more often in non-radiology journals. A disproportionate number of review articles were published early on and were based on little original pediatric imaging data. CT scan reports, which represent the standard, outnumbered radiographic reports and indicated that ground-glass opacification is the main imaging finding and that only a quarter of scans are normal in children with COVID-19.

Use of Andrographis paniculata (Burm.f.) Wall. ex Nees and risk of pneumonia in hospitalised patients with mild coronavirus disease 2019: A retrospective cohort study.

BackgroundAndrographis paniculata (Burm.f.) Wall. ex Nees (AP) has been widely used in Thailand to treat mild COVID-19 infections since early 2020; however, supporting evidence is scarce and ambiguous. Thus, this study aimed to examine whether the use of AP is associated with a decreased risk of pneumonia in hospitalised mild COVID-19 patients.Materials and methodsWe collected data between March 2020 and August 2021 from COVID-19 patients admitted to one hospital in Thailand. Patients whose infection was confirmed by real-time polymerase chain reaction, had normal chest radiography and did not receive favipiravir at admission were included and categorised as either AP (deriving from a dried and ground aerial part of the plant), given as capsules with a total daily dose of 180 mg andrographolide for 5 days or standard of care. They were followed for pneumonia confirmed by chest radiography. Multiple logistic regression was used for the analysis controlling for age, sex, diabetes, hypertension, statin use, and antihypertensive drug use.ResultsA total of 605 out of 1,054 patients (mostly unvaccinated) were included in the analysis. Of these, 59 patients (9.8%) developed pneumonia during the median follow-up of 7 days. The incidence rates of pneumonia were 13.93 (95% CI 10.09, 19.23) and 12.47 (95% CI 8.21, 18.94) per 1,000 person-days in the AP and standard of care groups, respectively. Compared to the standard of care group, the odds ratios of having pneumonia in the AP group were 1.24 (95% CI 0.71, 2.16; unadjusted model) and 1.42 (95% CI 0.79, 2.55; fully adjusted model). All sensitivity analyses were consistent with the main results.ConclusionThe use of AP was not significantly associated with a decreased risk of pneumonia in mild COVID-19 patients. While waiting for insights from ongoing trials, AP’s use in COVID-19 should be done with caution.

When a Headache Is More than the Flu: A Case Report.

IntroductionWhen influenza (flu) season arrives, it is easy for emergency department clinicians to anchor on the diagnosis of flu, sending patients on their way with or without anti-influenza medication. It is important not to miss the outlier – the patient who seems to have typical symptoms of influenza but with certain subtleties that should make one consider expanding the differential diagnosis.Case ReportWe describe an 11-year-old previously healthy male who presented with eight days of fever, myalgias, cough, congestion, and headache in the context of positive influenza exposure. The length and severity of his symptoms prompted laboratory and imaging investigation. He was positive for influenza type B with elevated inflammatory markers but otherwise normal laboratory workup and normal chest radiograph. He complained of a headache and was given fluids and antipyretics, and was admitted for overnight observation. He specifically did not have any forehead swelling. The next day during his inpatient stay he developed right frontal forehead edema and appeared ill. He was taken for a sinus computed tomography, which showed changes consistent with frontal bone osteomyelitis. Even after drainage by neurosurgery and otolaryngology, the patient subsequently developed repeat abscesses and ultimately a superior sagittal sinus thrombosis.ConclusionOther sources of infection should be considered in patients who have flu-like symptoms that last longer than expected, present with focality, or appear ill.

Performance Analysis of Different Convolutional Neural Network (CNN) Models with Optimizers in Detecting Tuberculosis (TB) from Various Chest X-ray Images

Tuberculosis (TB) is one of the top 10 infectious disease-related deaths. This paper uses Convolutional Neural Networks (CNN) to investigate the accuracy and performance of three pre-trained models with different optimizers and loss functions to diagnose tuberculosis based on the patient's chest X-ray scans. The odds of treating and curing tuberculosis (TB) are better if the disease is diagnosed early in a patient. Early detection of tuberculosis could lead to a decreased overall mortality rate. The best and quickest way to identify tuberculosis is to look at the patient's chest X-Ray image (CXR). A qualified professional Radiologist is required to make an accurate diagnosis. But do not have qualified doctor or radiologist everywhere. On the other hand, it is quite difficult for a doctor or radiologist to diagnose from any x-ray images with open eyes. 914 normal chest x-ray images and 892 TB infected images were used from different sources to train and evaluate these images to detect the exact x-ray of Tuberculosis infected people. Different famous pre-trained models like VGG16, InceptionV3 and Xception etc. were applied. Approximately 80% of the data was used for training and the remaining 20% was used for validation. From all of these datasets, randomly 190 images from normal and 180 images from TB chest x-ray images have been taken. Those randomized 370 (190 for TB and 180 for normal) images were used to evaluate the data finally. Performance of different algorithm like VGG16, InceptionV3 and Xception by applying different optimizers (Adam, Adadelta, Adagrad, Adamax, RMSprop, Nadam, SGD), different loss functions (Binary Cross Entropy, Hinge, Squared Hinge), varying input image size and also varying batch size were also been recorded. Note that, huge variations of performance for different combinations of algorithm, optimizer, loss function, input image size, batch size have been observed. Confusion matrix, precision, recall, f1-score value have also been recorded to understand and justify how accurately the model is predicting the disease from different angles.

CovMnet-Deep Learning Model for classifying Coronavirus (COVID-19).

Diagnosing COVID-19, current pandemic disease using Chest X-ray images is widely used to evaluate the lung disorders. As the spread of the disease is enormous many medical camps are being conducted to screen the patients and Chest X-ray is a simple imaging modality to detect presence of lung disorders. Manual lung disorder detection using Chest X-ray by radiologist is a tedious process and may lead to inter and intra-rate errors. Various deep convolution neural network techniques were tested for detecting COVID-19 abnormalities in lungs using Chest X-ray images. This paper proposes deep learning model to classify COVID-19 and normal chest X-ray images. Experiments are carried out for deep feature extraction, fine-tuning of convolutional neural networks (CNN) hyper parameters, and end-to-end training of four variants of the CNN model. The proposed CovMnet provide better classification accuracy of 97.4% for COVID-19 /normal than those reported in the previous studies. The proposed CovMnet model has potential to aid radiologist to monitor COVID-19 disease and proves to be an efficient non-invasive COVID-19 diagnostic tool for lung disorders.

Medical Image of the Month: An Unexpected Cause of Chronic Cough

No abstract available. Article truncated after 150 words. Sometimes it is as simple as it looks! A previously healthy nonsmoking 40-year-old man presented with a 7-month history of dry cough which was misdiagnosed as asthma. He had persistent cough despite appropriate asthma treatment including empiric PPIs. This patient had undergone extensive lab work up and evaluation; from negative viral and fungal panel, repeated pulmonary function tests which were within normal limits, chest x-rays, and CT scans which had shown small local calcification in the bronchus intermedius with significant thickening of the surrounding bronchial wall (Figure 1). The decision was made to proceed with flexible bronchoscopy, which yielded a chicken bone fragment with surrounding granulation tissue as shown in Figure 2A. In retrospect the bone is visible within the bronchus intermedius on the topogram from the CT scan, see Figure 2B. Foreign body aspiration in adults reported in low rates (0.66 per 100 000) (1). Despite being uncommon, neurological …

Modified Haller index is inversely correlated with true positive exercise stress echocardiographic results.

The influence of chest wall shape on exercise stress echocardiography (ESE) results has been poorly investigated. We aimed at evaluating the main predictors of true positive (TP)-ESE in a population of subjects with suspected coronary artery disease (CAD), categorized according to chest wall conformation, assessed by modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine). All consecutive patients with suspected CAD referred to our EchoLab for performing ESE between September 2011 and October 2021 were retrospectively enrolled. Preliminary assessment of both pretest probability (PTP) and MHI was performed. All patients with positive ESE underwent coronary angiography. Obstructive CAD was diagnosed by ≥70% stenosis in any epicardial coronary artery. Outcome was TP ESE result. One thousand two hundred and seventy-five consecutive patients (64.9 ± 13.0 years) entered the study. Subjects with concave-shaped chest wall (MHI > 2.5) (10.7%) and those with normal chest shape (MHI ≤ 2.5) (89.3%) were separately analyzed. PTP was similar in both groups (21.8 ± 13.2 vs. 23.5 ± 13.3%, P = 0.15). One hundred and seventy patients were diagnosed with positive ESE: 129 (75.9%) had obstructive CAD (TP), whereas the remaining 41 (24.1%) had no CAD. Only 2.3% of TP ESE was detected in subjects with MHI >2.5. PTP [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04], dyslipidemia (OR 4.37, 95% CI 2.81-6.80), dyssynergy in the left anterior descending territory (OR 8.21, 95% CI 5.07-13.3) were linearly correlated with TP ESE, whereas MHI >2.5 (OR 0.25, 95% CI 0.14-0.67) was inversely associated with outcome. Subjects with MHI >2.5 have low prevalence of TP ESE, regardless of PTP. Preliminary MHI assessment may reduce overestimation of PTP of CAD.