Background-Aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular (LV) dysfunction entails a higher surgical risk. Though it may improve symptoms and LV size, it is not known whether it translates into a survival benefit. Methods and Results-This retrospective cohort study included patients screened from our echocardiographic database between 1993 and 2007 for patients with severe AR and LV ejection fraction (EF) Յ35%. Charts reviews were conducted for clinical, pharmacological, and surgical information. Mortality data were obtained from the social security death index and analyzed as a function of AVR adjusted for the propensity score. Of the 785 patients with severe AR, 166 patients had severe LV dysfunction defined as an EF Յ35%: 69% of these were men, age 65Ϯ16 years, and LV EF was 23Ϯ8%. Kaplan-Meier analysis revealed that performance of AVR (nϭ53) was associated with a better survival (Pϭ0.001). Adjusted for the propensity score, AVR was associated with a significantly lower mortality hazard (HR 0.59, CI 0.42 to 0.98, Pϭ0.04). Conclusions-There is a clear reluctance to offer AVR in a large number of patients with severe AR associated with LV dysfunction. However, the performance of AVR in these patients is associated with a mortality benefit supporting the current ACC/AHA guidelines. (Circulation. 2009;120[suppl 1]:S134-S138.)
Background
: Growing numbers of American Veterans are diagnosed with psychological disorders and myocardial infarctions without known preexisting cardiac risk factors. Confronted with this information, we studied the association between psychological disorders and the presence of coronary artery calcium. High risk coronary calcification [Agatston method coronary artery calcium score (CAC) >100] is associated with a striking increase in cardiovascular events (hazard ratio>10) making it an excellent surrogate marker.
Methods
: From a database of VA patients who have undergone cardiac computed tomography, 483 were studied (age 59±12 years, 86% male). Regression analysis was utilized for comparison of CAC score for individuals with depression, anxiety, post-traumatic stress disorder (PTSD) and substance abuse..
Results
: After adjustment for age, gender and cardiac risk factors, the odds ratio of CAC≥100 vs. CAC=0 was 1.24 (95% CI 1.02–2.08, p=0.044) for depression, 2.04 (95% CI 1.11– 6.17, p=0.027) for anxiety, 2.28 (95% CI 1.15–5.76, p=0.026) for PTSD and 2.61 (95% CI 1.14 – 6.03, p=0.022) for substance abuse as compared to normal cohort.
Conclusion
: Veterans with psychological disorders were found to have a significantly higher coronary artery calcification score than those without such disorders. These findings are independent of age, gender and other traditional cardiac risk factors.
BACKGROUND:
Ambient air pollution from traffic increases cardiovascular morbidity and mortality and is associated with coronary artery calcification. Whether this increased risk is mediated by severity of coronary artery disease (CAD) remains unknown.
METHODS:
In this pilot study, the relationship between living near a major roadway and multivessel CAD confirmed by invasive coronary angiographic was explored. Subjects undergoing coronary angiography in the Los Angeles metropolitan area in 2009-10 were randomly selected. Investigators blinded to the exposure status reviewed coronary angiograms. Subjects were categorized as having: absence of or non-obstructive CAD, 1-vessel, 2-vessel, or 3-vessel CAD based upon the number of major epicardial vessels with > 70% stenoses. The distance from each subject's residence to the nearest major road was calculated in meters. Multivariate logistic regression was used to explore the relationship between severity of CAD and distance to major roadway.
RESULTS:
There were 642 subjects undergoing coronary angiography. The mean age (SD) was 64 years (12) and 36% were female. In multivariate analysis log-road distance was a predictor of multivessel CAD, odds ratio (OR) = 0.85 (95%CI, 0.75-0.98; p=0. 02) after adjusting for age, gender, hypertension, and diabetes, and smoking status. Other predictors of multivessel CAD included from the multivariate logist model were: male gender (OR, 3.00, 95% CI, 2.06-4.39; p<0.001), diabetes (OR, 2.49; 95% CI, 1.75-3.54; p<0.001), and hypertension 2.58; 95%CI, 1.28-5.21; p=0.008). The most severe form of CAD, >50% stenosis of the left main artery, was observed in 6.6% of the cohort. In a multivariate model, age (P = 0.002) and diabetes (P = 0.002) were significant predictors of severe left main disease; there was a trend for log-road distance (OR, 0.83; 95% CI, 0.67-1.02; P = 0.079) with left main disease.
CONCLUSIONS:
Multivessel CAD was strongly associated with traditional risk factors. After adjusting for these factors, living near a major roadway was also a predictor. This study demonstrates the feasibility of exploring the association between angiographic CAD and traffic pollution. Additional studies are needed to better understand the mechanisms underlying the increase in adverse cardiovascular events from air pollution.
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