Normal thoracic aortic diameter in Thai people by multidetector computed tomography.

OBJECTIVE: To determine the normal size of the thoracic aorta among Thai people. MATERIAL AND METHOD: The aortic diameter of 73 Thai males and 56 Thai females, in four age groups, were measured from thoracic Multidetector Computed Tomography (MDCT) images. Aortic size were analyzed and correlated by age, sex, and vertebral body. RESULTS: All showed normal aortic configuration, i.e. smooth tapering from aortic root to ascending and descending aorta. Mean aortic diameters were 3.12 cm at proximal ascending aorta, 2.95 cm at distal ascending aorta, 2.59 cm at mid arch, 2.33 cm at proximal descending aorta, 2.14 cm at distal descending aorta, and 2.03 cm at diaphragm. Males' aorta were larger than females, and all levels of the aorta were significantly enlarged with increasing age. Tapering of the vessel ratio of the ascending aorta/distal aorta at diaphragm was 1.5 without statistical significance. There was a weak correlation between aortic size and vertebral body at all levels. Comparing the size of the aorta to that of the vertebrae, the aorta was larger at the ascending part, equal at the mid arch and smaller at the descending part. CONCLUSION: Among the Northern Thai people, the average size of the aorta was determined at each level. It was found that aortic size is significantly dependent on age, sex, and vertebral body width.

Evidence of influenza or influenza-like-illness preceding acute coronary syndrome.

This observational study determined the prevalence of influenza and influenza-like-illness (ILI) in patients hospitalized for acute coronary syndrome (ACS). Serological confirmation and a clinical history of influenza or a recent acute upper respiratory infection were obtained in 376 patients admitted to Maharaj Nakhon Chiang Mai Hospital, Thailand, from June 2006 through May 2007 for ACS. We found evidence of confirmed influenza preceding ACS in 47 patients (12.5%) and for recent ILI in 41 patients (11%). There were more influenza and ILI patients admitted in the winter than in other months. Influenza vaccination may be protective in high risk patients.

In-hospital invasive strategy and outcomes in non-ST elevation acute coronary syndrome management from Thai Acute Coronary Syndrome Registry.

BACKGROUND: The management guideline of acute coronary syndrome has been changed in recent years, especially in the group of non-ST elevation acute coronary syndrome (NSTE-ACS). Presently, there is no existing guideline in Thailand. Additionally, several different management factors of health care from Western countries being used. OBJECTIVE: Evaluate the real management strategy, including the utilization of invasive management and pharmacotherapy of NSTE-ACS Thai patients in the absence of official clinical management guideline. MATERIAL AND METHOD: Thai Acute Coronary Syndrome (Thai ACS) Registry is a large, observational prospective, population-based registry designed to collect the data of "real-life" patient management. The full details of methods have been published in the present supplement. RESULTS: Five thousand five hundred and thirty-seven consecutive patients were registered between August 1, 2002 and July 31, 2005. Among these patients, 3,548 (64.1%) were diagnosed with non-ST elevation myocardial infarction (NSTEMI) and 1,989 (35.9%) with unstable angina. Coronary angiography was performed during hospitalization in 2,476 patients (44.7%). From 2,476 patients who underwent coronary angiogram, 405 (16.4%) had revascularization within 2 days and 1,019 (42.9%) after 2 days. Overall, in-hospital mortality was 9.5% and cardiac mortality was 6.3%. Patients with NSTEMI had more than 4 times the mortality of patients with unstable angina (13.1 vs. 3.0%, p < 0.001). Patients who received only medical treatment without coronary angiogram had the highest mortality rate. The in-hospital outcomes were not different between patients who received early or delayed revascularization. CONCLUSION: Mortality rate of NSTEACS in the authors' registry was very high. NSTEMI had the worse prognosis. Invasive strategy is associated with better in-hospital outcome but is underutilized.

A predictive model for distinguishing ischemic from non-ischemic cardiomyopathy.

OBJECTIVES: To develop a predictive model to distinguish ischemic from non-ischemic cardiomyopathy MATERIAL AND METHOD: The authors randomly assigned 137 patients with LV systolic dysfunction into two subsets--one to derive a predictive model and the other to validate it. Clinical, electrocardiographic and echocardiographic data were interpreted by blinded investigators to the subsequent coronary angiogram results. Ischemic cardiomyopathy was diagnosed by the presence of significant coronary artery disease from the coronary angiogram. The final model had been derived from the clinical data and was validated using the validating set. The receiver-operating characteristics (ROC) curves and the diagnostic performances of the model were estimated. RESULTS: The authors developed the following model: Predictive score = (3 x presence of diabetes mellitus) + number of ECG leads with abnormal Q waves--(5 x presence of echocardiographic characteristic of nonischemic cardiomyopathy). The model was well discriminated (area under ROC curve = 0.94). Performance in the validating sample was equally good (area under ROC curve = 0.89). When a cut-off point > or = 0 was used to predict the presence of significant coronary artery disease, the model had a sensitivity, specificity and positive and negative predictive values of 100%, 57%, 74% and 100%, respectively. CONCLUSION: With the high negative value of this model, it would be useful for use as a screening tool to exclude non-ischemic cardiomyopathy in heart failure patients and may avoid unnecessary coronary angiograms.