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2004| June-Aug | Volume 5 | Issue 2
June 22, 2010
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Chairman's Reflections : Blood-letting
Hajar A Hajar Albinali
June-Aug 2004, 5(2):74-85
Right atrial thrombus mimicking right atrial tumor
Sayed M Abdou, Rachel Hajar
June-Aug 2004, 5(2):66-69
What does my patient's coronary artery calcium score mean? combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk
Mark J Pletcher, Jeffrey A Tice, Michael Pignone, Charles McCulloch, Tracy Q Callister, Warren S Browner
June-Aug 2004, 5(2):44-54
The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information.
We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios.
Among 9341 asymptomatic study participants (age 35-88 years, 40% female), we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham) to 6-9%; if her score were over 100, however (a 17% chance), her risk estimate would be markedly higher (25-51% in 10 years). In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management.
Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.
ART AND MEDICINE
Aristotle with a Bust of Homer
June-Aug 2004, 5(2):72-73
Transthoracic doppler echocardiography: Noninvasive diagnostic window for coronary flow reserve assessment
Pawel Petkow Dimitrow
June-Aug 2004, 5(2):55-65
This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR) in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery). Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.
CONTROVERSIES IN CARDIOLOGY
Catheter delivered devices are not preferred over surgery for management of secundum ASD
Richard A Jonas
June-Aug 2004, 5(2):39-43
A PICTURE IS WORTH A THOUSAND WORDS
Left Ventricular Pseudoaneurysm or True Aneurysm?
June-Aug 2004, 5(2):70-71
June-Aug 2004, 5(2):36-38
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