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Objective: To study the prevalence of non-calcified plaque causing significant coronary artery stenosis in patients with zero or low coronary artery calcium scores in a regional hospital in Hong Kong. Methods: Computed tomography reports and clinical records (at least 3 years after computed tomography coronary angiography) of 336 consecutive patients with coronary artery calcium scores and computed tomography coronary angiography performed with a 64-slice multi-detector computed tomography scanner from January 2007 to December 2008 were retrospectively reviewed. Patients with zero and low coronary artery calcium scores were analysed for prevalence of atherosclerotic plaque and degree of arterial luminal stenosis. Results: The records of 194 patients with zero (n = 130; 67.0%) and low (n = 64; 33.0%) coronary artery calcium scores were included. Non-calcified plaque was found in 20 (15.4%) patients with zero coronary artery calcium score and 49 (76.6%) patients with low coronary artery calcium score. Significant coronary artery stenosis (>50% luminal diameter stenosis) by non-calcified plaque was found in five (3.8%) patients with zero coronary artery calcium score and 18 (28.1%) patients with low coronary artery calcium score. Subsequent cardiac catheterization was performed in three patients with zero coronary artery calcium score (mean follow-up, 34.5 months; standard deviation, 6.3 months); the result was in agreement with computed tomography coronary angiography for one patient and two had overestimation of stenosis. Subsequent cardiac catheterizations were performed in 11 patients with low coronary artery calcium score; the results were in agreement with computed tomography coronary angiography for 10 patients and one had overestimation of stenosis. Conclusions: Absence of coronary artery calcium does not exclude obstructive coronary artery disease. Low coronary artery calcium score is not reliable in predicting non-calcified plaque burden.

Diffuse myocardial calcification is very rare and can be either dystrophic or metastatic. Acute / subacute development of diffuse myocardial calcification of the left ventricle in an acute setting has been rarely reported but is found in a septic patient in our case. We believe that the cause of myocardial calcification is likely multifactorial. In particular, high-dose inotropic support is likely a contributing cause of calcification due to cardiomyopathy. More importantly, it is associated with very poor cardiac function and high mortality.

BackgroundInappropriate testing for Clostridium difficile infection (CDI) may result in diagnosis of CDI in asymptomatic carriers with diarrhea due to other causes such as laxatives. Current guidelines suggest that periodic chart review may be useful to assess the appropriateness of CDI testing, but it is not known how accurate the medical record is in documenting diarrhea.MethodsWe conducted a prospective cohort study of 80 patients tested for CDI to determine the accuracy of diarrhea documentation in the medical record in comparison to patient interviews and to assess the appropriateness of testing.ResultsThirty-five of 80 (44%) CDI tests were deemed inappropriate because patients either did not have clinically significant diarrhea (i.e., 3 or more unformed stools per day) or had an alternative explanation for diarrhea. Seventy-four of 80 (93%) patients stated they had diarrhea, but only 53 (66%) had clinically significant diarrhea based on symptom review. Physician and/or nursing notes documented diarrhea in 67 of 80 (84%) patients, but the number of bowel movements and the consistency of stool were documented for only 36 (45%) and 41 (51%) patients.ConclusionIn our facility, inappropriate CDI testing was common and the accuracy of the medical record in documenting diarrhea was suboptimal. Education of patients and providers may be beneficial in improving the accuracy of diarrhea documentation and the appropriateness of testing.Disclosures All authors: No reported disclosures.