The purpose of this retrospective study was to determine measurements of adrenal glands from longitudinal sonograms, in a large population of dogs and to correlate these measurements to age, sex and descriptors of body size. Dogs were selected from the clinic population presented for routine abdominal ultrasonography between September, 1991 and March, 1994. Dogs with elevated serum cholesterol or alkaline phosphatase levels, polyuria/polydipsia, and/or clinical diagnoses of adrenal pathology were excluded. Dogs with ultrasound-documented abnormalities (mass lesions, abnormal architecture) of either adrenal were not considered. Age, sex, weight and breed were recorded, and the body surface area of each dog was calculated. Adrenal length and caudal polar width were determined from longitudinal, two-dimensional ultrasound images. Adrenal measurements were compared with body size measurements and age using least squares linear regression analysis and the correlation coefficient (r) and coefficient of determination (r2) calculated. One hundred and ninety three dogs were included in the study, with a weight and body surface area range of 1.8-72 kg and 0.2-1.8 m2, respectively. The left adrenal gland (n = 182) length range was from 10.7 to 50.2 mm, and the range of the caudal polar widths was 1.9 to 12.4 mm. Right adrenal gland (n = 85) length range was from 10 to 39.3 mm, and the range of the caudal polar widths was from 3.1 to 12 mm. In dogs where both adrenal gland lengths were measured (n = 74), the right adrenal gland length was less than that of the left in 46 dogs, equal to the left in one dog, and greater than the length of the left in 27 dogs. The strongest linear association was noted between the left adrenal gland length and body weight (kg, r = 0.71, p < 0.0001) or body surface area (m2, r = 0.71, p < 0.0001). Similar significant association was noted between the right adrenal gland length and body weight (kg, r = 0.69, p < 0.0001). A significant positive association was also noted between age and left adrenal gland length, (r = 0.25, p = 0.009). The summation of all four adrenal measurement values (left length and width, right length and width) did slightly improve the correlation (r = 0.74, p < 0.0001) when compared with body weight (kg). There was not a significant difference in the adrenal measurements with regard to sex. With regard to the correlation coefficient values, there was no advantage noted to calculating the body surface area from body weight. The causes for the low degrees of the correlation between adrenal size and the variables investigated in this study are unknown; measurement error, effects of non-adrenal illness on adrenal size, and a non-linear or complex linear relationship between adrenal gland size (as measured by longitudinal parameters) and descriptors of body size are among possible explanations.

NCT00921960.

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AimsWe undertook a mixed‐methods evaluation of a Web‐based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs.Methods and resultsAll cases from June 2015 to October 2016 were recorded using a standardized recording template, which recorded patient demographics, medical history, medications, and outcome of the virtual consult for each case. Quantitative surveys and qualitative interviewing of 17 participating GPs were also undertaken. During this time, 142 cases were discussed—68 relating to a new diagnosis of heart failure, 53 relating to emerging deterioration in a known heart failure patient, and 21 relating to therapeutic issues. Only 17% required review in outpatient department following the virtual consultation. GPs reported increased confidence in heart failure management, a broadening of their knowledge base, and a perception of overall better patient outcomes.ConclusionsThese data from an initial experience with Heart Failure Virtual Consultation present a very positive impact of this strategy on the provision of heart failure care in the community and acceptability to users. Further research on the implementation and expansion of this strategy is warranted.

Background The purpose of this study was to investigate the utility of BNP, hsTroponin-I, interleukin-6, sST2, and galectin-3 in predicting the future development of new onset heart failure with preserved ejection fraction (HFpEF) in asymptomatic patients at-risk for HF. Methods This is a retrospective analysis of the longitudinal STOP-HF study of thirty patients who developed HFpEF matched to a cohort that did not develop HFpEF (n = 60) over a similar time period. Biomarker candidates were quantified at two time points prior to initial HFpEF diagnosis. Results HsTroponin-I and BNP at baseline and follow-up were statistically significant predictors of future new onset HFpEF, as was galectin-3 at follow-up and concentration change over time. Interleukin-6 and sST2 were not predictive of future development of new onset HFpEF in this study. Unadjusted biomarker combinations of hsTroponin-I, BNP, and galectin-3 could significantly predict future HFpEF using both baseline (AUC 0.82 [0.73,0.92]) and follow-up data (AUC 0.86 [0.79,0.94]). A relative-risk matrix was developed to categorize the relative-risk of new onset of HFpEF based on biomarker threshold levels. Conclusion We provided evidence for the utility of BNP, hsTroponin-I, and Galectin-3 in the prediction of future HFpEF in asymptomatic event-free populations with cardiovascular disease risk factors.

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Abstract:Context Natriuretic peptide (NP) has been shown to be an effective screening tool to identify patients with Stage B heart failure and to have clinical value in preventing heart failure progression . The impact of associated metabolic confounders on the screening utility of NP needs clarification. ObjectiveTo assess the impact of diabetes (DM) on NP screening for asymptomatic Stage B heart failure. Materials and MethodsThe study population consisted of 1368 asymptomatic patients with cardiovascular risk factors recruited from general practice as part of the STOP-HF trial. B-type NP (BNP) was quantified at pointof-care. ResultsBNP was found to be as accurate for detecting Stage B heart failure in DM patients compared to non-DM patients (AUC 0.75 [0.71,0.78] and 0.77 [0.72,0.82], respectively). However, different BNP thresholds are required to achieve the same level of diagnostic sensitivity in DM compared with non-DM patients. To achieve 80% sensitivity a difference of 5ng/L lower is required for patients with diabetes. ConclusionAlthough a significantly different BNP threshold is detected for patients with DM, the BNP concentration difference is small and unlikely to warrant a clinically different diagnostic threshold.3 Background: