Quadrant laser photocoagulation trial to ameliorate choroidal congestion in central serous chorioretinopathy.

PURPOSE: To investigate the efficacy and safety of quadrant laser photocoagulation to ameliorate the choroidal congestion in central serous choroidopathy (CSC). STUDY DESIGN: Historically controlled study. METHODS: We prospectively studied 20 eyes with acute CSC in the quadrant laser group, in which laser photocoagulation was applied to the macular leakage point(s) as well as the quadrant of the fundus showing vortex vein dilatation. Central choroidal thickness (CCT), vertical diameter of dilated vortex vein, resolution rate of serous retinal detachment (SRD), and visual field were evaluated post-treatment. We also compared the results with those of 18 retrospectively analyzed eyes with acute CSC in an external control group, in which laser photocoagulation had been applied only to the macular leakage point(s). RESULTS: In the quadrant laser group, 2 eyes were excluded from data analysis due to choroidal neovascularization (CNV). CCT was significantly reduced in both groups, but more significantly in the quadrant laser group. The vertical diameter of the dilated vortex vein was significantly decreased only in the quadrant laser group. The resolution rate of SRD was similar in the two groups. In the quadrant laser group, 8 eyes (44.4%) showed mild deterioration of the visual field, consistent with the area subjected to quadrant laser photocoagulation. CONCLUSION: Quadrant laser photocoagulation can have limited efficacy for ameliorating vortex vein congestion in CSC. When laser photocoagulation to the macular area is combined with quadrant laser photocoagulation, attention must be paid to the possible development of CNV and visual field deterioration.

The Assessment of the Efficacy and Safety of Favipiravir for Patients with SARS-CoV-2 Infection: A Multicenter Non-randomized, Uncontrolled Single-arm Prospective Study.

Objective Among treatment options for coronavirus infectious disease 2019 (COVID-19), well-studied oral medications are limited. We conducted a multicenter non-randomized, uncontrolled single-arm prospective study to assess the efficacy and safety of favipiravir for patients with COVID-19. Methods One hundred participants were sequentially recruited to 2 cohorts: cohort 1 (Day 1: 1,600 mg/day, Day 2 to 14: 600 mg/day, n=50) and cohort 2 (Day 1: 1,800 mg/day, Day 2 to 14: 800 mg/day, n=50). The efficacy endpoint was the negative conversion rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the odds ratio (OR) of cohort 2 to cohort 1 for negative conversion on Day 10 was calculated. Characteristics of all participants and profiles of adverse events (AEs) were collected and analyzed. Results The mean age of participants was 62.8±17.6 years old. Thirty-four patients (34.0%) experienced worsening pneumonia, 7 (7.0%) were intubated, and 4 (4.0%) died during the observation period. Cohort 2 showed a higher negative conversion rate than cohort 1 [adjusted OR 3.32 (95% confidence interval (CI), 1.17 to 9.38), p=0.024], and this association was maintained after adjusting for the age, sex, body mass index, and baseline C-reactive protein level. Regarding adverse events, hyperuricemia was most frequently observed followed by an elevation of the liver enzyme levels (all-grade: 49.0%, Grade ≥3: 12.0%), and cohort 2 tended to have a higher incidence than cohort 1. However, no remarkable association of adverse events was observed between patients <65 and ≥65 years old. Conclusion The antiviral efficacy of favipiravir was difficult to interpret due to the limitation of the study design. However, no remarkable issues with safety or tolerability associated with favipiravir were observed, even in elderly patients with COVID-19.

Impact of left atrial enlargement on image quality in coronary computed tomography angiography.

PURPOSE: To assess the associations between simple measurements of left atrial (LA) size and image quality of coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: Four hundred and nineteen patients who underwent CCTA were retrospectively examined. Image quality was measured by coronary artery attenuation and contrast-to-noise ratio (CNR) of the proximal coronary artery (mean values of right coronary artery and left main trunk). LA transverse (LA-TRA) and anterior-posterior (LA-AP) diameter were measured on non-contrast CT images of the chest. The relationships of coronary attenuation and CNR with LA diameters were assessed by Pearson's correlation or Spearman's rank correlation coefficient and multivariate linear regression analysis. Receiver operating characteristic curves were used to assess the predictive value of LA diameters for image quality. RESULTS: Both coronary artery attenuation value and CNR were independently correlated with LA-AP diameter (r = -0.38, for artery attenuation; r = -0.16, for CNR, both p < 0.001), and LA-TRA diameter (r = -0.2, p < 0.001, for artery attenuation; r = -0.11, p = 0.02, for CNR), respectively. With a cutoff value of 34 mm, the LA-AP diameter had a sensitivity of 85.2%, a specificity of 68.4% and an area under curve (AUC) of 0.77 for prediction of insufficient image quality (coronary artery attenuation less than 326 Hounsfield units). CONCLUSION: Coronary artery attenuation and CNR in CCTA decreased with larger LA size.

Pulmonary Artery Diameter (PAD) and the Pulmonary Artery to Aorta Ratio (PAD/AAD) as Assessed by Non-contrast Cardiac CT: The Association with Left Ventricular (LV) Remodeling and the LV Function.

Objective Dilatation of the pulmonary artery itself (PAD: pulmonary artery diameter) or in relation to the ascending aorta (PAD/AAD: pulmonary artery diameter to ascending aortic diameter ratio) has been reported to be associated with pulmonary hypertension and with a prognostic outcome of either heart failure or cardiovascular events. We herein aimed to assess the correlations between pulmonary hypertension-related parameters PAD (or PAD/AAD) and left ventricular (LV) remodeling and LV function. Methods This retrospective study included 193 patients (ages: 67±12 years) who underwent both coronary CT angiography (CCTA) and echocardiography. The PAD and the AAD were measured on a transaxial non-contrast CCTA image at the level of the pulmonary artery bifurcation. Left ventricular mass (LVM), relative wall thickness ratio (RWT), left ventricular ejection fraction (LVEF), left atrial volume (LAV), and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were evaluated by echocardiography. The relationships between PAD (or PAD/AAD) and echocardiography parameters were assessed, and adjusted for the demographic data and cardiovascular disease (CVD) risk factors by a multivariable linear regression analysis. Results PAD (mean±SD: 2.6±0.4 cm) was positively correlated with LVM (r=0.34, p<0.001), LAV (r=0.41, p<0.001), and E/e' (r=0.29, p<0.001). PAD/AAD (mean±SD: 0.76±0.12 cm) was positively correlated with LVM (r=0.12, p=0.09), LAV (r=0.24, p<0.001), and E/e' (r=0.15, p=0.04). These correlations remained significant after adjusting for demographic data and CVD risk factors. PAD (or PAD/AAD) did not correlate with LVEF or RWT (p>0.05). Conclusion Greater PAD or PAD/AAD is significantly associated with LV remodeling and an impaired LV function.

Association of Uric Acid with Incident Metabolic Syndrome in a Japanese General Population.

Uric acid is associated with cardiovascular disease (CVD) and its risk factors. Here, we examined the association between the serum uric acid level and incident metabolic syndrome in a Japanese general population. This retrospective, observational study was based on data obtained from an annual health checkup program in Gunma Prefecture, Japan. We evaluated 14,793 participants who did not use antihypertensive or antidiabetic medications and did not present with CVD or metabolic syndrome at the study baseline in 2009. Metabolic syndrome was defined as per the Japanese diagnostic criteria. A discrete proportional hazards regression model was used to evaluate the association between the serum uric acid level at baseline and the incident metabolic syndrome through 2012 and was adjusted for age, gender, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, and triglyceride. At baseline, the average age of the participants was 48.9 years, who were comprised of 40% women. The mean serum uric acid level at baseline was 5.3 ± 1.4 mg/dL. During the three-year follow-up, 7% of the cohort (n = 1,031) developed metabolic syndrome. The uric acid level was strongly associated with incident metabolic syndrome in the multivariable model (adjusted hazard ratio: 1.10; 95% confidence interval, 1.04-1.17; P < 0.01 per 1 mg/dL increase for uric acid). Higher uric acid levels were independently associated with a greater risk of incident metabolic syndrome in a Japanese general population.

Impact of uric acid on incident hypertension: Sex-specific analysis in different age groups.

The aim of the present study is to evaluate the association of serum uric acid (UA) levels with the risk of incident hypertension among different age groups in men and women using a single large Japanese general cohort. The present study is based on annual health check-up program in Gunma, Japan. We studied 12,029 participants (mean age, 48 â€‹± â€‹9 years old; 31% women) free of prevalent cardiovascular disease and hypertension at baseline (2009). Hypertension was defined by self-report, hypertensive medication use, or measured BP â€‹> â€‹140/90 â€‹mmHg â€‹at each visit. Discrete proportional hazards regression model was used to evaluate the association of UA level at baseline with incident hypertension through 2012 adjusted for age, gender, baseline blood pressure, and other CVD risk factors among different age decade groups in men and women. During follow-up of 3 years, 12% of the cohort (n â€‹= â€‹1457) developed hypertension. UA was strongly associated with incident hypertension in the multivariable model in all participants. In age-stratified analysis, participants below 50 years of age in men had the significant association of UA with incident hypertension, whereas participants above 50 years did not. In women, participants above 40 years had the significant association, whereas participants below 40 years did not. The present data suggest that UA level is an independent predictor for incident hypertension among middle aged men below 50 years old and middle aged and the elderly women above 40 years.

Influence of cardiac function on image quality in coronary computed tomography angiography.

PURPOSE: To evaluate the correlation between cardiac functional parameters and image quality in coronary computed tomography angiography (CCTA). MATERIAL AND METHODS: Sixty-six patients who underwent both CCTA and echocardiography were included. The coronary artery attenuation values and contrast-to-noise ratios (CNR) were measured in the proximal right coronary arteries (RCA) and left main (LM) trunk. Then, the averages of the mean values derived from RCA and LM were calculated. The cardiac output (CO), left atrial (LA) volume, and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were measured by echocardiography. The relationship of cardiac parameters with arterial attenuation and CNR were assessed by Pearson's correlation, Spearman's rank correlation and multivariable linear regression analysis adjusted for age, gender, body surface area and heart rate. RESULTS: The coronary artery attenuation value was negatively correlated with CO (r = -0.30, p = 0.01) and LA volume (r = -0.37, p = 0.002). CNR was negatively correlated with LA volume (r = -0.4, p = 0.001) and E/e' (r = -0.27, p = 0.03). These associations remained significant in the multivariable analysis. CONCLUSION: CO and diastolic function had an impact on image quality of CCTA. Adjusting CCTA protocol may improve image quality in patients with known diastolic dysfunction or reduced cardiac output.

Association of Aortic Arch Width Assessed by Noncontrast Cardiac Computed Tomography With Cardiac Remodeling, Cardiac Function, and Atherosclerosis in a Japanese Cohort.

PURPOSE: Age-related aortic changes are related to adverse cardiac remodeling and reduced cardiac function. Here, we aim to assess the correlations between aortic arch width (AAW) and left ventricular (LV) remodeling and LV function as well as coronary artery calcification (CAC). MATERIALS AND METHODS: This retrospective study included 194 patients (ages, 67±12 y) who underwent both coronary computed tomography angiography and echocardiography. The AAW is defined as the longest width between the ascending and descending aorta on a transaxial noncontrast coronary computed tomography angiography image at the level of the pulmonary artery bifurcation. Left ventricular mass, relative wall thickness ratio, left ventricular ejection fraction, left atrial volume, and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were evaluated by echocardiography. CAC was assessed by Agatston score. The relationships between AAW and echocardiography parameters were assessed, and adjusted for demographic data and cardiovascular disease risk factors by multivariate linear regression analysis. RESULTS: AAW (mean±SD, 11.6±1.4 cm) was positively correlated with left ventricular mass (r=0.28, P<0.0001), left atrial volume (r=0.28, P<0.0001), and E/e' (r=0.21, P<0.01). These correlations remained significant after adjustment for demographic data and cardiovascular disease risk factors. There was no correlation between AAW and left ventricular ejection fraction or relative wall thickness. There was a significant difference of AAW between the groups with Agatston score <100 and those with Agatston score ≥100, and this difference persisted after adjustment for all covariates (P<0.01). CONCLUSION: Greater AAW was significantly associated with LV remodeling and impaired function as well as advanced CAC.