[DOES INCIDENTAL CALCIUM DEPOSITION IN NON-CARDIAC CT SCANS PREDICT CARDIOVASCULAR MORBIDITY AND MORTALITY IN YOUNG ADULTS - A RETROSPECTIVE STUDY].

INTRODUCTION: Calcium score (CS) in cardiac CT scans represents an effective tool in the early diagnosis of cardiovascular disease. Few studies evaluated the value of incidental arterial calcification (AC) in non-cardiac CT scans, especially in young adults with no prior cardiovascular disease. AIMS: To examine the relationship between arterial calcifications and the incidence of cardiovascular events. METHODS: A retrospective study in patients aged 40-51 years old with no history of cardiovascular disease who underwent chest CT scans between 1.9.2012-31.8.2013 for reasons not related to cardiovascular disease. We assessed the presence of AC in the aorta and coronary arteries and its association with the rates of coronary catheterization for acute coronary syndrome (ACS), cardiac mortality and emergency room (ER) visits or hospitalizations for cardiovascular disease. Furthermore, we examined the association between AC and atherosclerotic risk factors. RESULTS: A total of 407 patients underwent CT scans for non-cardiovascular reasons within the timeframe specified; 308 were included in the study, 150 men and 158 women with average follow-up period of 7.2+0.29 years. There was an increased frequency in ACS and coronary catheterizations in patients with a positive AC compared to those with null AC (11.6% vs. 0.5% respectively, P= 0.0001, OR = 29.1). A positive AC was found more in men than women (35% vs. 20.9% respectively, P=0.006, OR=2.18). Patients with a positive AC had more ER and hospital admissions (33.7 % vs. 14.4% respectively, P<0.0001, OR=3). Patients with diabetes, hypertension and hyperlipidemia exhibited higher rates of positive AC. CONCLUSIONS: Although multivariate analysis is still to be conducted, it seems that AC is associated with cardiovascular morbidity and increased incidence of coronary catheterizations. Primary preventive strategies in patients with positive AC may reduce cardiovascular morbidity and mortality.

[AMIODARONE-INDUCED THYROTOXICOSIS - RISK FACTORS AND PREDICTORS OF OUTCOME: A RETROSPECTIVE STUDY].

BACKGROUND: Amiodarone induced thyrotoxicosis (AIT) occurs with considerable incidence and is associated with significant morbidity and mortality. Factors that predict poor prognosis in this disease have not yet been sufficiently investigated. OBJECTIVES: We examined the characteristics and short-term clinical outcomes of patients with AIT (up to six months from diagnosis). We evaluated the relationship between T3 and T4 levels at time of presentation and complications associated with AIT. METHODS: A retrospective epidemiological study was conducted reviewing all cases diagnosed with thyrotoxicosis and amiodarone consumption of patients treated in the Carmel Medical Center between the years 2004-2008. We examined the characteristics of patients who tend to develop AIT. In addition, we examined whether T3 and T4 levels at the time of presentation were a predictor of a poor prognosis. Three major complications associated with AIT were defined as primary outcomes within six months of diagnosis: 1. mortality; 2. development of AIT-related complications that required hospitalization; 3. the need for thyroidectomy. RESULTS: A total of 400 patients were diagnosed with thyrotoxicosis and consumed amiodarone. However, only 39 patients met the definition of AIT. The composite outcome of mortality, AIT-related complications and thyroidectomy were found in the vast majority of patients (94.8%, 37 out of 39 participants); 3 (7.6%) died and 35 (89.7%) were hospitalized with AIT-related complications and 8 (20.5%) required thyroidectomy. We found a statistically significant relationship between high T4 levels (above 64.3 mcg/dL or above 3 times the upper limit of the norm) and the composite of two main endpoints: mortality and the need for thyroidectomy in the first half year of diagnosis (P=0.009). CONCLUSIONS: AIT is associated with significant morbidity and mortality. An elevated level of free T4 reflects the severity of AIT. In patients with significantly increased T4 values, an early surgical intervention should be considered.