Plasma lipidomic analysis can predict the burden of non-calcified coronary plaque in asymptomatic subjects at intermediate risk of CAD. Re-stratification of these patients by plasma lipid profiling may enable more appropriate and effective primary prevention management strategies.
Cardiac magnetic resonance (CMR) imaging may allow more appropriate selection of patients for cardiac device implantation and/or cardiac surgery. In this prospective observational study we evaluated the impact of CMR imaging on cardiac device and surgical therapy. All CMR examinations performed in a single centre over a 2 year period were prospectively recorded in a dedicated database under 4 clinical pathways [cardiomyopathy, viability, tumour/mass and arrythmogenic right ventricular cardiomyopathy (ARVC)]. Baseline data entered included planned cardiac device implantation and/or cardiac surgical intervention. Patients were contacted 6 months following CMR to evaluate the impact of CMR on planned therapy. Cost savings due to CMR were calculated as the number of surgical or device procedures averted following CMR scanning multiplied by their respective cost weights. Of 732 CMR examinations performed, the clinical pathway was cardiomyopathy in 488 (67 %), ARVC in 118 (16 %), viability in 92 (12 %) and tumour/mass in 34 (5 %). Six month follow-up was available in 666/732 patients. Following CMR, 56/150 (37 %) of patients with an initial plan for device implantation or cardiac surgery, did not undergo the planned intervention (P < 0.001, one-sample exact binomial test). Of 516 patients without an initial device or surgical plan, 33 (6 %) CMR resulted in device implantation or cardiac surgery (P < 0.001, Chi squared). Overall, the estimated saving due to CMR-guided management changes was AUD$737,270. CMR has a significant impact on patient management and offers potential cost savings with respect to selection of device and surgical therapy for cardiac disease.
Background: High-sensitivity troponin T (hs-TnT) is commonly used in the diagnosis of myocardial infarction (MI). However, factors other than ischaemia are increasingly recognised to influence baseline hs-TNT and this is of particular importance in avoiding inappropriate "rule in" or delayed "rule out" of MI. We sought to determine the impact of increasing age on baseline hs-TnT levels.Methods: Data on all patients with hs-TnT measurements in our Emergency Department over an eight-month period between 2010 and 2011 were reviewed. Those with a clinical suspicion of ACS, a significant rise or fall in hs-TnT or those other acute illnesses known to elevate hs-TnT were excluded. Demographics, clinical details and laboratory investigations were obtained from the medical records.Results: Of 3219 patients with hs-TnT measurements taken, 615 were excluded because of suspected ACS and 1287 for other reasons, including impaired renal function (eGFR <45 ml/h/m 2 ), arrhythmia, sepsis and acute heart failure. Of the remaining 1317 patients, 39.6% were male and the median age was 63 years (16-101). Multivariate analysis identified increasing age (p < 0.001) as the strongest independent predictor of elevated hs-TnT. Other independent predictors included prior myocardial infarction (p = 0.01), atrial fibrillation (p < 0.001), gender (p < 0.0001), smoking (p = 0.04), renal dysfunction (p < 0.0001) and hypertension (p < 0.005).Conclusion: Our data suggest increasing age is independently associated with elevated levels of hs-TnT. Elderly patients without myocardial infarction commonly have hs-TnT levels above the currently recommended upper limit of normal. It may therefore be necessary to define age specific upper limits of normal for hs-TnT. http://dx.
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