Obstructive sleep apnea (OSA), characterized by partial or complete occlusion of the pharynx during sleep, results in persistent inspiratory effort and interruption of airflow. During each episode of apnea, OSA patients develop increased transmural pressure in the aortic wall. Accordingly, to test the hypothesis that the presence of OSA would be associated with greater thoracic aortic size, we prospectively assessed 150 consecutive patients, newly referred to the sleep clinic in our institution, in a crosssectional study to confirm OSA. The patients underwent sleep study and chest computed tomography (CT)-derived thoracic aortic diameter. In this particular period, a chest CT was performed within 3 months of the sleep study upon informed consent to our protocol. Exclusion criteria included: 1) prior history of aortic dissection, aortic valvular disease, and clinical characteristics of Marfan's syndrome; 2) central sleep apnea; 3) treatment for sleep apnea; and 4) dialysis. The outer diameter of the ascending aorta was measured by caliper within the CT image. Overnight sleep study was performed using cardiopulmonary monitoring (Morpheus, Teijin Inc., Tokyo, Japan). The apnea-hypopnea index (AHI) was quantified as the frequency of apneas and hypopneas per hour of bed time. OSA was defined as AHI Ն10/h. The data are presented as mean Ϯ SD or frequencies. To determine the independent factors, the multiple linear regression model with backward elimination technique was used, including older age, male gender, blood pressure, hypertension, dyslipidemia, diabetes mellitus, ischemic heart disease, smoking, and AHI. Comparisons between the 2 groups were performed by Student t test for the unadjusted aortic diameter and by analysis of covariance for the adjusted aortic diameter.The patients' mean age was 60 Ϯ 11 years; 125 (83%) were men, with mean body mass index of 24.7 Ϯ 3.1 kg/m 2 . Fifty-nine percent of patients had hypertension. At assessment, 91% of patients had already taken prescribed antihypertensive medications. One hundred ten patients (73%) had OSA. On univariate analysis, older age, male gender, body mass index, systolic blood pressure, pulse pressure, hypertension, dyslipidemia, ischemic heart disease, and AHI were positively correlated with thoracic aortic size. On multivariate analysis, older age (per 10-year increase, coefficient 1.82, 95% confidence interval [CI]: 1.13 to 2.34, p Ͻ 0.001), male gender (coefficient 3.25, 95% CI: 1.63 to 4.87, p Ͻ 0.001), and AHI (per 10-event/h increase, coefficient 0.62, 95% CI: 0.25 to 0.98, p Ͻ 0.001) remained as factors associated with greater thoracic aortic diameter. Contrarily, there was no significant independent relationship between blood pressure/hypertension and thoracic aortic size. Additionally, patients with OSA had a significantly greater thoracic aortic size than those without OSA (p Ͻ 0.001) (Fig. 1), even if adjusted for older age and male gender (p Ͻ 0.001).Increased thoracic aortic size is known to be related to aging, male, genetic mutation including M...
Background: Myocardial injury can be detected more sensitively using 123 I-radioiodinated 15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) than thallium-201 (TL). The present study investigated whether 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) uptake as an index of active inflammation in patients with cardiac sarcoidosis (CS) is associated with BMIPP and TL findings, and whether dual single-photon emission computed tomography (SPECT) can facilitate diagnosis of CS. Methods and Results:We retrospectively enrolled 52 consecutive patients with suspected CS who were assessed on FDG-PET/computed tomography (CT) and BMIPP/TL dual SPECT. The SPECT images were divided into 17 segments and then BMIPP and TL total defect scores (BMDS, TLDS) as well as mismatch scores (BMDS-TLDS: sumMS) were calculated. Maximum standardized uptake value (SUVmax) in the entire myocardium was obtained from FDG-PET/CT. SUVmax was much higher in patients with, than without CS (P<0.0001). BMDS was higher and sumMS much higher in CS (P<0.05 and P<0.0001, respectively). The sensitivity and specificity of sumMS to detect CS were 74% and 80%, respectively. SUVmax was not associated with either BMDS or sumMS in the patients with CS. On multivariate analysis, the combination of sumMS and SUVmax had greater prognostic significance compared with each parameter on its own. equipped with low-energy general-purpose collimators. Data were acquired over 180° in 32 steps of 50 s each in a 64×64 matrix with electrocardiographic gating of 8 frames per cardiac cycle. The TL and BMIPP data were obtained using symmetrical 72±10-and 159±10-keV windows, respectively, to separate the distribution of the isotopes. 18 Conclusions CMRPatients without the relevant contraindication underwent CMR. Cardiac MR images were acquired on either Intera Achieva 1.5T (Phillips) or Ingenia 3.0T (Phillips) with a cardiac-dedicated phased-array coil. Cine images were acquired in multiple short-axis, vertical long-axis and 4-chamber view for assessment of LV function. Ten minutes after the additional administration of 0.1 mmol/kg gadolinium-DTPA, short-axis and 4-chamber images were obtained with spin echo to assess for the presence of late gadolinium-enhancing (LGE) lesions.
While recent guidelines for the treatment of acute heart failure syndromes (AHFS) recommend pharmacotherapy with vasodilators in patients without excessively low blood pressure (BP), few reports have compared the relative efficiency of vasodilators on hemodynamics in AHFS patients. The present study aimed to assess the differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with AHFS. Thirty-eight consecutive patients were assigned to receive 48-h continuous infusion of carperitide (n = 19; 0.0125-0.05 μg/kg/min) or nicorandil (n = 19; 0.05-0.2 mg/kg/h). Hemodynamic parameters were estimated at baseline, and 2, 24, and 48 h after drug administration using echocardiography. After 48 h of infusion, systolic BP was significantly more decreased in the carperitide group compared with that in the nicorandil group (22.1 ± 20.0 % vs 5.3 ± 10.4 %, P = 0.003). While both carperitide and nicorandil significantly improved hemodynamic parameters, improvement of estimated pulmonary capillary wedge pressure was greater in the carperitide group (38.2 ± 14.5 % vs 26.5 ± 18.3 %, P = 0.036), and improvement of estimated cardiac output was superior in the nicorandil group (52.1 ± 33.5 % vs 11.4 ± 36.9 %, P = 0.001). Urine output for 48 h was greater in the carperitide group, but not to a statistically significant degree (4203 ± 1542 vs 3627 ± 1074 ml, P = 0.189). Carperitide and nicorandil were differentially effective in improving hemodynamics in AHFS patients. This knowledge may enable physicians in emergency wards to treat and manage patients with AHFS more effectively and safely.
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