scholarly journals Identification of a pharmacological inhibitor of Epac1 that protects the heart against acute and chronic models of cardiac stress

2019 ◽  
Author(s):  
Marion Laudette ◽  
Antonio Coluccia ◽  
Yannis Sainte-Marie ◽  
Andrea Solari ◽  
Loubina Fazal ◽  
...  
Keyword(s):  
Cardiac Stress ◽  
Pharmacological Inhibitor ◽  
Chronic Models

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals The early identification of psychosis: can lessons be learnt from cardiac stress testing?

2015 ◽  
Vol 233 (1) ◽  
pp. 19-37 ◽  
Author(s):  
Swapnil Gupta ◽  
Mohini Ranganathan ◽  
Deepak Cyril D’Souza
Keyword(s):  
Early Identification ◽  
Stress Testing ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

Exhaled nitric oxide estimation by a simple and efficient noninvasive technique and its utility as a marker of airway inflammation in mice

2009 ◽  
Vol 107 (1) ◽  
pp. 295-301 ◽  
Author(s):  
Tanveer Ahmad ◽  
Ulaganathan Mabalirajan ◽  
Duraisamy Arul Joseph ◽  
Lokesh Makhija ◽  
Vijay Pal Singh ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Airway Inflammation ◽  
Airway Remodeling ◽  
Allergen Challenge ◽  
Allergic Airway Inflammation ◽  
Ambient Air ◽  
Exhaled Nitric Oxide ◽  
Noninvasive Technique ◽  
Modified Method ◽  
Chronic Models

Allergic airway inflammation (AI) is commonly associated with enhanced exhaled nitric oxide (ENO) in both humans and mice. Since mouse models are being used to understand various mechanisms of asthma, a noninvasive, simple, and reproducible method to determine ENO in mice is required for serial nonterminal assessment that can be used independent of environmental situations in which the ambient air contains substantial amounts of NO as a contaminant. The aim of this study was to noninvasively measure ENO in individual mice and to test its utility as a marker of AI in different models of allergic AI. We modified the existing ENO measuring methods by incorporating flushing and washout steps that allowed simple but reliable measurements under highly variable ambient NO conditions (1–100 ppb). This method was used to serially follow ENO in acute and chronic models of allergic AI in mice. ENO was reproducibly measured by this modified method and was positively correlated to AI in both acute and chronic models of asthma but was not independently related to airway remodeling. Resolution of AI and other related parameters in dexamethasone-treated mice resulted in reduction of ENO, further confirming this association. Restriction of allergen challenge to pulmonary but not nasal airways was associated with a smaller increase in ENO compared with allergen challenge to both. Hence, ENO can now be reliably measured in mice independent of ambient NO levels and is a valid biomarker for AI. However, nasal and pulmonary airways are likely to be independent sources of ENO, and any results must be interpreted as such.

Abstract TP165: Cardiac Screening Does not Improve One-year Mortality Among Patients With Cerebrovascular Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura J Myers ◽  
John Concato ◽  
Linda S Williams ◽  
...  
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Stress Testing ◽  
Cerebrovascular Event ◽  
Mortality Benefit ◽  
Cardiac Stress ◽  
Cardiac Screening ◽  
All Cause Mortality ◽  
Cardiac Stress Testing ◽  
One Year

Introduction: Guidelines recommend the use of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a ‘high risk’ Framingham Cardiac Risk score (FCRS). It is unclear whether implementation of this guideline confers a mortality benefit among patients with cerebrovascular disease. Hypothesis: We assessed the hypothesis that cardiac stress testing would be associated with lower odds of one-year all-cause mortality. Methods: Administrative data from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a stroke or TIA in fiscal year 2011 were analyzed. Patients were excluded (n=6915) on the basis of: prior CHD history, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, death within 90 days of discharge, being discharged to hospice, transferred to a non-VHA acute care facility, or missing/unknown race. A FCRS was calculated for each patient; a score of ≥ 20% was classified as ‘high risk’ of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 90-days after the cerebrovascular event. Logistic regression was used to assess whether cardiac stress testing was associated with one-year all-cause mortality. Results: Of the 4391 eligible patients, 62.8% (2759) had FCRS ≥ 20%, with 4.5% (n=123) of these patients receiving cardiac stress testing within 90 days of discharge. After adjusting for sociodemographic characteristics and medical comorbidities, FCRS ≥ 20% was associated with one-year mortality (aOR=2.18; CI 95 :1.59, 3.00), however, receipt of stress testing was not (aOR=0.59; CI 95 :0.26, 1.30). Conclusion: Cardiac screening did not confer a one-year all-cause mortality benefit among patients with cerebrovascular disease. Additional work is needed to assess outcomes among patients with cerebrovascular disease who are at ‘high risk’ for CHD.

Abstract 15317: Risk of Future Adverse Events in Patients Receiving Class IC Antiarrhythmic Drugs Who Have Elevated Coronary Artery Calcium Scores But Low-risk Cardiac Stress Test

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael J Cutler ◽  
Heidi T May ◽  
T Jared Bunch ◽  
Raymond O McCubrey ◽  
Brian G Crandall ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Adverse Events ◽  
Antiarrhythmic Drugs ◽  
Stress Test ◽  
Qualitative Assessment ◽  
Cardiac Stress ◽  
Quantitative Score ◽  
Stable Cad ◽  
One Year

Background: Class IC antiarrhythmic drugs (AAD) are a standard treatment of cardiac arrhythmias but are associated with harm in patients with prior myocardial infarction (MI)). Consensus guidelines have advocated that these drugs not be used in patients with coronary artery disease (CAD). However, the risk of Class IC AAD in patients with stable CAD, as demonstrated by an elevated coronary artery calcium (CAC) , but a low-risk cardiac stress test (LRCST), remains unclear. We hypothesized that the risk of future adverse cardiovascular events would not differ according to CAC severity among patients with an LRCST on Class Ic AAD treatment. Methods: We identified 355 patients without CAD and an LRCST (<5% ischemia) on cardiac stress PET before initiation of Class IC AAD. CAC was assessed using quantitative scores when available or qualitative CAC assessment on low-dose attenuation correction CT. Patients were divided into no/low CAC (i.e., quantitative score <100 or qualitative assessment of none/mild) or mod/severe CAC (i.e., quantitative score ≥100 or qualitative assessment of moderate/severe) The composite primary endpoint for this analysis was ventricular tachycardia/fibrillation (VT/VF), cardiac arrest, and all-cause death at one-year follow-up. Results: The majority of patients had no/low CAC (n = 278 [78.3%]) compared to mod/severe CAC (n = 77 [21.7%]). Those with no/low CAC were younger (62 vs 70, p<0.0001) and were more likely to have a higher BMI (33.1 v 30.4, p=0.007) when compared to the mod/severe CAC group. Other cardiovascular risk factors were similar between groups. There was no difference in the one-year primary composite outcome of VT/VF, cardiac arrest, and death between no/low CAC compared to mod/severe CAC (3.6% vs 5.2%, p=0.51). Conclusion: In patients receiving Class IC AAD therapy with an LRCST, an elevated CAC did not increase the risk of future adverse events. These data suggest that using Class IC AAD may be safe in patients with stable CAD (no ischemia/elevated CAC). Future prospective trials are needed to evaluate the safety of Class IC AAD in patients with elevated CAC.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

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