| 1 | Significance of inferior wall ischemia in non-dominant right coronary artery anatomy显示文摘AIM To investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with nondominant right coronary artery anatomy.METHODS This was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain.Only patients who underwent single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)were included.Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed.Patients with prior history of coronary artery disease(CAD)including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded.True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography,in the same territory as identified on SPECT MPI.Coronary artery dominance was determined on coronary angiography.Patients were divided into group 1 and group 2.Group1 included patients with non-dominant right coronary artery(RCA)(left dominant and codominant).Group2 included patients with dominant RCA anatomy.Demographics,baseline characteristics and positive predictive value(PPV)were analyzed for the two groups.RESULTS The mean age of the study cohort was 57.6 years.Sixtyone point seven percent of the patients were males.The prevalence of self-reported diabetes mellitus,hypertension and dyslipidemia was 36%,71.9%and 53.9%respectively.A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men.For inferior wall ischemia on SPECT MPI,patients in study group 2 had a significantly higher PPV,32/42(76.1%),compared to patients in group 1,in which only 3 out of the 29 patients(10.3%)had true positive results(P value<0.001 Z test).The difference remained statistically significant even when only patients with left dominant coronary system(without co-dominant)were compared to patients with right dominant system(32/40,76.1%in right dominant group,3/19,15.8%in left dominant group,P value<0.001 Z test).There was no significant difference in mean hospital stay,re-hospitalization,and in-hospital mortality between the two groups.CONCLUSION The positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance.More studies are needed to explain this phenomenon. | Ali Osama Malik Oliver Abela Subodh Devabhaktuni Arhama Aftab Malik Gayle Allenback Chowdhury H Ahsan Sanjay Malhotra Jimmy Diep | 2017 | World Journal of Cardiology2017，9，3： | 2 |
| 2 | Gender differences,outcomes and trends among nonagenarian with atrial fibrillation:insight from National Inpatient Sample database显示文摘BACKGROUND Nonagenarians(NG),individuals aged≥90 years,constitute an increasing proportion of hospitalizations presenting with atrial fibrillation(AF).However,not much is known about demographics,clinical outcomes,and trends of hospitalizations.Therefore,we analyzed data about hospitalizations and clinical outcomes among NGs with AF over ten years from 2005 to 2014 using a publically available database,the National Inpatient Sample.METHODS All hospitalizations and major outcomes of subjects≥90 years with a primary diagnosis of AF(ICD-9-CM code 427.31)over a ten-year period were assessed in this study by multivariate logistic regression analysis.RESULTS There were more females than males(176,268 females,51,384 males)in this analysis.The number of hospitalizations for AF among NG increased by 50%(17,295 in 2005 to 25,830 in 2014).Males were more likely to undergo cardioversion(6.14%of males vs.5.06%of females,P<0.0001).Over this period,in-hospital mortality declined from 3.21%in 2005 to 2.38%in 2014(P=0.0041),with higher in-hospital mortality in males(3.23%in males vs.2.76%in females,P=0.0138),mean length of hospitalization decreased from 4.53 days to 4.13 days(P<0.0001),the prevalence of congestive heart failure fell from 0.48%to 0.23%(P=0.0257),and the use of anticoagulation increased from 6.09%to 14.54%(P<0.0001).In a multivariate analysis,hospital admission on the weekend,Elixhauser comorbidity index,CHA2DS2VASc score,acute respiratory failure,and the length of hospital stay were associated with a higher risk of in-hospital mortality.CONCLUSIONS From 2005 to 2014,AF-related hospitalizations among NGs increased,more so in in females population,mortality trends improved,rates of anticoagulation increased,and cardioversions increased.Despite the decreasing trend of in-hospital mortality since 2005,the relatively high mortality rate in males warrants further studies. | Dinesh Voruganti Ghanshyam Shantha Sushma Dugyala Alexander Bolton Ala Mohsen Subodh Devabhaktuni Hakan Paydak Jawahar L Mehta | 2021 | Journal of Geriatric Cardiology2021，18，2： | 0 |
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