Single-center experience in the management of spontaneous isolated abdominal aortic dissection

OBJECTIVE This study aims to report the management of patients with spontaneous isolated dissection of the abdominal aorta (sIAAD). METHODS A cohort of 18 consecutive patients (12 male, mean age 58 years) with sIAAD was treated between 1990 and 2009. Dissection was asymptomatic in ten and symptomatic in eight patients. Retrospective data analysis from patient charts was performed. Follow-up included clinical examination, ultrasound, and/or CT-angiography. Mean follow-up was 54 months (range 1-211). RESULTS In total, eight out of 18 received invasive treatment. All asymptomatic patients initially underwent conservative treatment and surveillance. Spontaneous false lumen thrombosis occurred in four (40 %), and three patients showed relevant aneurysmatic progression and underwent elective invasive treatment (open n = 2, endovascular n = 1), representing a crossover rate of 30 %. Late mortality was 20 % (n = 2) in this group. In symptomatic patients, five underwent urgent treatment due to persistent abdominal or back pain (n = 4) or contained rupture (n = 1); one was treated for claudication. The remaining two patients presented with irreversible spinal cord ischemia and were treated conservatively. Three patients were treated by open surgery and three by endovascular interventions (two stentgrafts, one Palmaz XXL stent). Early and late morbidity and mortality was 0 % in this group. There were no reinterventions CONCLUSION: The majority of patients with sIADD require invasive treatment, with EVAR being the preferable treatment option today. In asymptomatic IADD, primary surveillance is justifiable, but close surveillance due to expansion is necessary.

Microangiopatía trombótica en paciente con síndrome antisintetasa : a propósito de un caso

Las microangiopatías trombóticas se caracterizan por presentar anemia hemolítica microangiopática asociada a plaquetopenia, fallo renal y lesión neurológica. El Síndrome anti-sintetasa es una entidad poco frecuente perteneciente al grupo de las miopatías inflamatorias idiopáticas. El objetivo de esta presentación es comunicar una paciente que desarrolló una púrpura trombocitopénica trombótica en el contexto de un Síndrome anti-sintetasa, asociación inusualmente reportada.

Chaperonas moleculares y tolerancia a estrés abiótico en especies arbóreas

Las temperaturas extremas, la sequía y otros estreses abióticos limitan la producción forestal de forma significativa, causando grandes pérdidas económicas en el sector. Los árboles, al ser organismos sésiles, han desarrollado una serie de estrategias para percibir dichos factores, activando respuestas defensivas apropiadas. Entre ellas ocupa un lugar preeminente la síntesis de proteínas con actividad chaperona molecular. Las chaperonas moleculares interaccionan con proteínas desnaturalizadas total o parcialmente, promoviendo su correcto plegamiento y ensamblaje. Las chaperonas moleculares que se sintetizan de forma predominante en plantas, pero no en otros eucariotas, pertenecen a la familia sHSP (small heat-shock proteins). Se trata de una familia inusualmente compleja y heterogénea, cuyos miembros son de pequeño tamaño (16-42 kD) y poseen un dominio “alfa-cristalina” muy conservado. Estas proteínas están implicadas en protección frente a estrés abiótico mediante la estabilización de proteínas y membranas, si bien su mecanismo de acción se conoce de forma incompleta. A pesar del evidente potencial aplicado de las proteínas sHSP, son muy escasos los estudios realizados hasta el momento con un enfoque netamente biotecnológico. Por otra parte, casi todos ellos se han llevado a cabo en especies herbáceas de interés agronómico o en especies modelo, como Arabidopsis thaliana. De ahí que las sHSP de arbóreas hayan sido mucho menos caracterizadas estructural y funcionalmente, y ello a pesar del interés económico y ecológico de los árboles y de su prolongada exposición vital a múltiples factores estresantes. La presente Tesis Doctoral se centra en el estudio de sHSP de varias especies arbóreas de interés económico. El escrutinio exhaustivo de genotecas de cDNA de órganos vegetativos nos ha permitido identificar y caracterizar los componentes mayoritarios de tallo en dos especies productoras de madera noble: nogal y cerezo. También hemos caracterizado la familia completa en chopo, a partir de su secuencia genómica completa. Mediante expresión heteróloga en bacterias, hemos analizado el efecto protector de estas proteínas in vivo frente a distintos tipos de estrés abiótico, relevantes para el sector productivo. Los resultados demuestran que las proteínas sHSP-CI: (i) aumentan la viabilidad celular de E.coli frente a casi todos estos factores, aplicados de forma individual o combinada; (ii) ejercen un rol estabilizador de las membranas celulares frente a condiciones adversas; (iii) sirven para mejorar la producción de otras proteínas recombinantes de interés comercial. El efecto protector de las proteínas sHSP-CI también ha sido analizado in planta, mediante la expresión ectópica de CsHSP17.5-CI en chopos. En condiciones normales de crecimiento no se han observado diferencias fenotípicas entre las líneas transgénicas y los controles, lo que demuestra que se pueden sobre-expresar estas proteínas sin efectos pleiotrópicos deletéreos. En condiciones de estrés térmico, por el contrario, los chopos transgénicos mostraron menos daños y un mejor crecimiento neto. En línea con lo anterior, las actividades biológicas de varias enzimas resultaron más protegidas frente a la inactivación por calor, corroborando la actividad chaperona propuesta para la familia sHSP y su conexión con la tolerancia al estrés abiótico. En lo que respecta a la multiplicación y propagación de chopo in vitro, una forma de cultivo que comporta estrés para las plantas, todas las líneas transgénicas se comportaron mejor que los controles en términos de producción de biomasa (callos) y regeneración de brotes, incluso en ausencia de estrés térmico. También se comportaron mejor durante su cultivo ex vitro. Estos resultados tienen gran potencial aplicado, dada la recalcitrancia de muchas especies vegetales de interés económico a la micropropagación y a la manipulación in vitro en general. Los resultados derivados de esta Tesis, aparte de aportar datos nuevos sobre el efecto protector de las proteínas sHSP citosólicas mayoritarias (clase CI), demuestran por vez primera que la termotolerancia de los árboles puede ser manipulada racionalmente, incrementando los niveles de sHSP mediante técnicas de ingeniería genética. Su interés aplicado es evidente, especialmente en un escenario de calentamiento global. ABSTRACT Abiotic stress produces considerable economic losses in the forest sector, with extreme temperature and drought being amongst the most relevant factors. As sessile organisms, plants have acquired molecular strategies to detect and recognize stressful factors and activate appropriate responses. A wealth of evidence has correlated such responses with the massive induction of proteins belonging to the molecular chaperone family. Molecular chaperones are proteins which interact with incorrectly folded proteins to help them refold to their native state. In contrast to other eukaryotes, the most prominent stress-induced molecular chaperones of plants belong to the sHSP (small Heat Shock Protein) family. sHSPs are a widespread and diverse class of molecular chaperones that range in size from 16 to 42k Da, and whose members have a highly conserved “alpha-crystallin” domain. sHSP proteins play an important role in abiotic stress tolerance, membrane stabilization and developmental processes. Yet, their mechanism of action remains largely unknown. Despite the applied potential of these proteins, only a few studies have addressed so far the biotechnological implications of this protein family. Most studies have focused on herbaceous species of agronomic interest or on model species such as Arabidopsis thaliana. Hence, sHSP are poorly characterized in long-lived woody species, despite their economic and ecological relevance. This Thesis studies sHSPs from several woody species of economic interest. The most prominent components, namely cytosolic class I sHSPs, have been identified and characterized, either by cDNA library screening (walnut, cherry) or by searching the complete genomic sequence (poplar). Through heterologous bacterial expression, we analyzed the in vivo protective effects of selected components against abiotic stress. Our results demonstrate that sHSP-CI proteins: (i) protect E. coli cells against different stressful conditions, alone or combined; (ii) stabilize cell membranes; (iii) improve the production of other recombinant proteins with commercial interest. The effects of CsHSP17.5-CI overexpression have also been studied in hybrid poplar. Interestingly, the accumulation of this protein does not have any appreciable phenotypic effects under normal growth conditions. However, the transgenic poplar lines showed enhanced net growth and reduced injury under heat-stress conditions compared to vector controls. Biochemical analysis of leaf extracts revealed that important enzyme activities were more protected in such lines against heat-induced inactivation than in control lines, lending further support to the chaperone mode of action proposed for the sHSP family. All transgenic lines showed improved in vitro and ex vitro performance (calli biomass, bud induction, shoot regeneration) compared to controls, even in the absence of thermal stress. Besides providing new insights on the protective role of HSP-CI proteins, our results bolster the notion that heat stress tolerance can be readily manipulated in trees through genetic engineering. The applied value of these results is evident, especially under a global warming scenario.

Incidencia, prevalencia y severidad de las lesiones deportivas en tres programas de entrenamiento para la pérdida de peso. Proyecto PRONAF

La práctica de actividad física y del deporte ha dado muestras indiscutibles sobre su relación con un buen estado de salud, tanto mental como corporal. Sin embargo, también entraña riesgos que pueden mermar la calidad de vida del practicante, siendo uno de los más comunes e importantes el riesgo de sufrir una lesión deportiva. Actualmente, se han dado respuesta a los factores de riesgo internos y externos que pueden afectar a que un deportista, tanto a nivel profesional como recreativo, pueda sufrir una lesión, pero pocos estudios se han realizado para evaluar la incidencia, la prevalencia y la severidad de las lesiones, en personas sedentarias con sobrepeso y obesidad que deciden comenzar a entrenar y/o a realizar actividad física. Incluso en aquellos casos que por razones clínicas, deben incluir el ejercicio físico como una parte integral del tratamiento terapéutico. Por lo tanto, el objetivo del estudio fue analizar la incidencia, prevalencia y severidad de las lesiones deportivas registradas en los protocolos de entrenamiento desarrollados durante el proyecto de Nutrición y Actividad Física para el tratamiento del sobrepeso y la obesidad (PRONAF). Se realizó un análisis descriptivo y se evaluó el efecto y el grado de asociación entre la incidencia de lesión y la composición corporal, el sexo o el protocolo de entrenamiento. Por otro lado, se observó la localización anatómica más común de las lesiones en cada una de las fases. Por último, se propuso una ecuación para estimar el riesgo de lesión en sujetos en sobrepeso y obesidad, antes de comenzar un programa de ejercicio controlado. Un total de 167 adultos con sobrepeso y obesidad sanos (77 hombres, 90 mujeres) fueron evaluados durante el proyecto mediante un registro de lesiones previamente validado. Los principales resultados de este trabajo mostraron que un 47,3% de los participantes sufrió, al menos, una lesión o dolencia durante el programa de intervención, observando una incidencia de 1,22 lesiones por cada 100 horas de entrenamiento. No obstante, se observó que el 80,2% de las lesiones fueron menores (de 1 a 7 días). La rodilla fue la localización que mayor proporción de lesiones registró durante la intervención. Por otro lado, no se observaron asociaciones significativas entre la fase de sobrepeso y la fase de obesidad, ni entre ser hombre o mujer y sufrir más lesiones durante la intervención. Sin embargo, los protocolos de entrenamiento que incluyen cargas, mostraron hasta cinco veces más riesgo de sufrir una lesión que el protocolo que no las incluyó. Por último, se propuso una ecuación para predecir la influencia de las variables fase, lesión previa, protocolo de entrenamiento, sexo y edad para predecir el riesgo de lesión en una población con sobrepeso y obesidad que incluya los protocolos de entrenamiento propuestos en el proyecto PRONAF. ABSTRACT The practice of physical activity and sport has indisputable signs on his relationship with a good health, both mental and physical. However, it is true that also risks that may impair the quality of life of the practitioner, one of the most common and important risk of sports injury. However, although they have responded to factors internal and external risks that may affect an athlete, both professional and recreational may suffer an injury, few studies have been conducted to assess the incidence and prevalence of injuries in sedentary people who decide to start training and / or physical activity. Even in those cases for clinical reasons, such as overweight and obesity, should include exercise as an integral part of therapy. Therefore, the aim of the study was to analyze the incidence, prevalence and severity of sports injuries registered training protocols developed during the project's Nutrition and Physical Activity for the treatment of overweight and obesity (PRONAF). A descriptive analysis was performed and the effect and the degree of association between the incidence of injury and body composition, sex or training protocol was evaluated. Furthermore, the most common anatomical injury location in each of the phases were observed. Finally, an equation for estimating the risk of injury in overweight and obese subjects, before starting a controlled exercise program was proposed A total of 167 healthy adults with overweight and obesity (77 men, 90 women) were evaluated during the project using a previously validated record injuries. The main results of this study showed that 47.3% of participants experienced at least one injury or illness during the intervention program, having an incidence of 1.22 injuries per 100 hours of training. However, it was observed that 80.2% of injuries were lower (1 to 7 days). Knee location was higher proportion of lesions that recorded during the procedure. On the other hand, no significant associations between the phase of overweight and obesity were observed phase or between being male or female and further injury during project. However, training protocols that included loads, showed up to five times the risk of injury to the protocol did not include them. Finally, an equation was proposed to predict the influence of the phase, previous injury, training protocol, sex and age to observe the risk of injury in a population of overweight and obesity with includes the training protocols proposed in the PRONAF project.

Analysis of the Drosophila host defense in domino mutant larvae, which are devoid of hemocytes

We have analyzed the Drosophila immune response in domino mutant larvae, which are devoid of blood cells. The domino mutants have a good larval viability, but they die as prepupae. We show that, on immune challenge, induction of the genes encoding antimicrobial peptides in the fat body is not affected significantly in the mutant larvae, indicating that hemocytes are not essential in this process. The hemocoele of domino larvae contains numerous live microorganisms, the presence of which induces a weak antimicrobial response in the fat body. A full response is observed only after septic injury. We propose that the fat body cells are activated both by the presence of microorganisms and by injury and that injury potentiates the effect of microorganisms. Survival experiments after an immune challenge showed that domino mutants devoid of blood cells maintain a wild-type resistance to septic injury. This resistance was also observed in mutant larvae in which the synthesis of antibacterial peptides is impaired (immune deficiency larvae) and in mutants that are deficient for humoral melanization (Black cells larvae). However, if domino was combined with either the immune deficiency or the Black cell mutation, the resistance to septic injury was reduced severely. These results establish the relevance of the three immune reactions: phagocytosis, synthesis of antibacterial peptides, and melanization. By working in synergy, they provide Drosophila a highly effective defense against injury and/or infection.

Preferential Zn2+ influx through Ca2+-permeable AMPA/kainate channels triggers prolonged mitochondrial superoxide production

Synaptically released Zn2+ can enter and cause injury to postsynaptic neurons. Microfluorimetric studies using the Zn2+-sensitive probe, Newport green, examined levels of [Zn2+]i attained in cultured cortical neurons on exposure to N-methyl-d-asparte, kainate, or high K+ (to activate voltage-sensitive Ca2+ channels) in the presence of 300 μM Zn2+. Indicating particularly high permeability through Ca2+-permeable α-amino3-hydroxy-5-methyl-4-isoxazolepropionic-acid/kainate (Ca-A/K) channels, micromolar [Zn2+]i rises were observed only after kainate exposures and only in neurons expressing these channels [Ca-A/K(+) neurons]. Further studies using the oxidation-sensitive dye, hydroethidine, revealed Zn2+-dependent reactive oxygen species (ROS) generation that paralleled the [Zn2+]i rises, with rapid oxidation observed only in the case of Zn2+ entry through Ca-A/K channels. Indicating a mitochondrial source of this ROS generation, hydroethidine oxidation was inhibited by the mitochondrial electron transport blocker, rotenone. Additional evidence for a direct interaction between Zn2+ and mitochondria was provided by the observation that the Zn2+ entry through Ca-A/K channels triggered rapid mitochondrial depolarization, as assessed by using the potential-sensitive dye tetramethylrhodamine ethylester. Whereas Ca2+ influx through Ca-A/K channels also triggers ROS production, the [Zn2+]i rises and subsequent ROS production are of more prolonged duration.

Mapping the awareness of inequalities in health programs in Spanish communities: moving forward together

The aim of this study is to map the awareness of gender, socioeconomic, immigrant and ethnic health inequalities in health at schools, maternal health and traffic injury health prevention programs. The study was conducted in the 19 health descentralized areas in Spain, 17 autonomous community (ACs) and the 2 autonomous cities (ACities). The data were collected from May 2008 to January 2009. The unit of analysis was the collection of policy documents setting out the programs mentioned above and the related support material in each AC. A reading guide was used to analyze the awareness of inequalities. With regard to health at schools, 2 of 10 programs show a high awareness of inequalities and include many specific proposals to be implemented at the local level. Regarding maternal health, 13 ACs have prepared support material with high awareness of inequalities to be implemented. A traffic injury program has been created in two ACs. We map the whole situation in Spain regarding the health programs that we have used as examples and their awareness of inequalities. We can conclude that there are differences between the regions studied in Spain and in general, the awareness of inequalities is low.

Implications physiopathologiques de la Nestine lors du remodelage pulmonaire et cardiaque à la suite de l’infarctus du myocarde, du diabète et de l’hypertension pulmonaire

Il est reconnu que la protéine filamenteuse intermédiaire Nestine est exprimée lors du processus de cicatrisation et du remodelage fibrotique. De plus, nous avons identifié l’expression de la Nestine au sein de deux populations distinctes qui sont directement impliquées dans les réponses de fibroses réparative et réactive. Ainsi, une population de cellules souches neurales progénitrices résidentes du coeur de rat adulte exprime la Nestine et a été identifiée à titre de substrat de l’angiogenèse et de la neurogenèse cardiaque. Également, la Nestine est exprimée par les myofibroblastes cicatriciels cardiaques et il a été établi que la protéine filamenteuse intermédiaire joue un rôle dans la prolifération de ces cellules. Ainsi, l’objectif général de cette thèse était de mieux comprendre les évènements cellulaires impliqués dans la réponse neurogénique des cellules souches neurales progénitrices résidentes cardiaques Nestine(+) (CSNPRCN(+)) lors de la fibrose réparative cardiaque et d’explorer si l’apparition de fibroblastes Nestine(+) est associée avec la réponse de fibrose réactive secondaire du remodelage pulmonaire. Une première publication nous a permis d’établir qu’il existe une régulation à la hausse de l’expression de la GAP43 (growth associated protein 43) et que cet événement transitoire précède l’acquisition d’un phénotype neuronal par les CSNPRCN(+) lors du processus de cicatrisation cardiaque chez le rat ayant subi un infarctus du myocarde. De plus, la surimposition de la condition diabétique de type 1, via l’injection unique de Streptozotocine chez le rat, abolit la réponse neurogénique des CSNPRCN(+), qui est normalement induite à la suite de l’ischémie cardiaque ou de l’administration de 6-hydroxydopamine. Le second article a démontré que le développement aigu de la fibrose pulmonaire secondaire de l’infarctus du myocarde chez le rat est associé avec une augmentation de l’expression protéique de la Nestine et de l’apparition de myofibroblastes pulmonaires Nestine(+). Également, le traitement de fibroblastes pulmonaires avec des facteurs de croissances peptidiques pro-fibrotiques a augmenté l’expression de la Nestine par ces cellules. Enfin, le développement initial de la condition diabétique de type 1 chez le rat est associé avec une absence de fibrose réactive pulmonaire et à une réduction significative des niveaux protéiques et d’ARN messager de la Nestine pulmonaire. Finalement, la troisième étude représentait quant à elle un prolongement de la deuxième étude et a alors examiné le remodelage pulmonaire chronique chez un modèle établi d’hypertension pulmonaire. Ainsi, les poumons de rats adultes mâles soumis à l’hypoxie hypobarique durant 3 semaines présentent un remodelage vasculaire, une fibrose réactive et une augmentation des niveaux d’ARN messager et de la protéine Nestine. De plus, nos résultats ont démontré que la Nestine, plutôt que l’alpha-actine du muscle lisse, est un marqueur plus approprié des diverses populations de fibroblastes pulmonaires activés. Également, nos données suggèrent que les fibroblastes pulmonaires activés proviendraient en partie de fibroblastes résidents, ainsi que des processus de transition épithélio-mésenchymateuse et de transition endothélio-mésenchymateuse. Collectivement, ces études ont démontré que des populations distinctes de cellules Nestine(+) jouent un rôle majeur dans la fibrose réparative cardiaque et la fibrose réactive pulmonaire.

Avaliação da perfusão esplénica em modelo de hemorragia de suíno, após reperfusão com duas soluções fisiológicas distintas

O baço tem importantes funções hematopoiéticas e imunológicas, desempenhando um papel crucial na reposição da hipovolemia e de volume sanguíneo, em situações de hemorragia aguda. A administração de soluções fisiológicas tem grande importância na correção do volume circulante, evitando as complicações de hipovolemia. Este trabalho tem como objetivo avaliar as alterações provocadas no baço, após grave hemorragia dos suínos e reperfusão, utilizando duas soluções fisiológicas distintas, um cristaloide - solução de ringer lactato e um coloide - solução de hidroxietilamido. As lesões histopatológicas encontradas no baço foram congestão, hiperplasia da polpa branca, a notoriedade dos elipsoides e o infiltrado inflamatório, razão pela qual, se procedeu à sua avaliação semi-quantitativa. Relativamente à hiperplasia da polpa branca, foram encontradas diferenças estatisticamente significativas entre o grupo Ringer Lactato e o grupo Hidroxietilamido, verificando-se o aumento da hiperplasia da polpa branca no grupo Ringer Lactato. Quanto à área dos elipsoides, apenas um suíno em cada grupo registava grau 1. Houve uma preponderância do grau 2 no grupo de controlo (n = 5) e no grupo Ringer Lactato (n = 11), enquanto que no grupo Hidroxietilamido se registaram valores idênticos para os graus 2 e 3 (n = 5). A congestão ocorreu em todos os grupos, com predomínio do grau 2 (n = 7) nos grupos Ringer Lactato e Hidroxietilmido. Relativamente ao infiltrado inflamatório, no grupo de controlo predominou o grau 1 (n = 5) e registou-se a prevalência do grau 2 no grupo Ringer Lactato (n = 8) e no grupo Hidroxietilamido (n = 9). A área dos elipsoides variou nos diferentes grupos, não tendo revelado diferenças significativas entre os grupos. Foi observada congestão nos três grupos do estudo, não tendo sido, contudo, registadas diferenças significativas entre os grupos. Quanto ao infiltrado inflamatório, verificou-se que no grupo de controlo predominou o grau 1, enquanto que nos grupos Ringer Lactato e Hidroxietilamido prevaleceu o grau 2, o que se justifica pelo facto dos grupos Ringer Lactato e Hidroxietilamido terem sido submetidos a uma hemorragia. Foi assim possível concluir que a reperfusão volémica com Hidroxietilamido 130/0.4 pode reduzir a hiperreatividade esplénica, quando comparado com o Ringer Lactato, após hemorragia aguda. Verificamos que os elipsoides não sofrem qualquer afetação em situações de alterações hemodinâmicos. Atualizamos um sistema de classificação para avaliação de congestão esplénica, usando o modelo suíno. Aferimos que as situações causadoras de alterações hemodinâmicas ou da perfusão tecidual provocam aumento do infiltrado inflamatório.

Surgical cryoablation for ventricular tachyarrhythmia arising from the left ventricular outflow tract region.

BACKGROUND Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) region can be inaccessible for ablation because of epicardial fat or overlying coronary arteries. OBJECTIVE We describe surgical cryoablation of this type of VA. METHODS From March 2009 to 2014, 190 consecutive patients with VAs originating from the LVOT underwent ablation at our institution. Four patients (2%) underwent surgical cryoablation for highly symptomatic VAs after failing catheter ablation. RESULTS In all patients, endocardial or percutaneous epicardial mapping was consistent with origin in the LVOT. In 2 patients, the points of earliest activation during VAs were marked with a bipolar pacing lead in the overlying cardiac vein for guidance during surgery. Surgical cryoablation was successful in 3 of the 4 patients. The fourth patient subsequently had successful endocardial catheter ablation. During a mean follow-up of 22 ± 16 months (range 4-42 months), all patients showed abolition of or marked reduction in symptomatic VA. However, 1 patient subsequently required percutaneous intervention to the left anterior descending coronary artery; another developed progressive left ventricular systolic dysfunction caused by nonischemic cardiomyopathy; and a third patient underwent permanent pacemaker implantation because of complete atrioventricular block after concomitant aortic valve replacement. CONCLUSION Surgical cryoablation is an option for highly symptomatic drug-resistant VAs emanating from the LVOT region. Despite extensive preoperative mapping, the procedure is not effective for all patients, and coronary injury is a risk.

Small car safety: an issue that needs further evaluation.

Mode of access: Internet.

An analysis of accidents in New York State by make of vehicle. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

The economic cost to society of motor vehicle accidents. 1986 addendum.

Mode of access: Internet.

MMF - final report 1971. Multidisciplinary accident investigation.

National Highway Traffic Safety Administration, Washington, D.C.

Screening for heart disease in diabetic subjects

Background The prevalence of left ventricular hypertrophy (LVH), coronary artery disease, and subclinical cardiomyopathy in diabetic patients without known cardiac disease is unclear. We sought the frequency of these findings to determine whether plasma brain natriuretic peptide (BNP) could be used as an alternative screening tool to identify subclinical LV dysfunction. Methods Asymptomatic patients with diabetes mellitus without known cardiac disease (n = 10 1) underwent clinical evaluation, measurement of BNP, exercise stress testing, and detailed echocardiographic assessment. After exclusion of overt dysfunction or ischemia, subclinical myocardial function was sought on the basis of myocardial systolic (Sm) and diastolic velocity (Em). Association was. sought between subclinical dysfunction and clinical, biochemical, exercise, and echocardiographic variables. Results Of 101 patients, 22 had LVH and 16 had ischemia evidenced by exercise-induced wall motion abnormalities. Only 4 patients had abnormal BNP levels; BNP was significantly increased in patients with LVH. After exclusion of LVH and coronary artery disease, subclinical cardiomyopathy was identified in 24 of 66 patients: Subclinical disease could not be predicted by BNP. Conclusions Even after exclusion of asymptomatic ischemia and hypertrophy, subclinical systolic and diastolic dysfunction occurs in a significant number of patients with type 2 diabetes. However, screening approaches, including BNP, do not appear to be sufficiently sensitive to identify subclinical dysfunction, which requires sophisticated echocardiographic analysis.