Coexistence and management of abdominal aortic aneurysm and coronary artery disease.

BACKGROUND: Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented. METHODS: 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD. RESULTS: Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms. CONCLUSIONS: Patients with AAA might benefit from an early coronary artery evaluation strategy.

Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches.

The aim of this study is to compare the two-dimensional transesophageal echocardiography (2D-TEE) with multi-slice computed tomography (MSCT) and with autopsied material to evaluate the ability and precision of the imaging methods for the detection and assessment of septal pouch (SP). One hundred and fifty patients that underwent both 2D-TEE and MSCT and 50 autopsied human hearts were investigated. In MSCT, the interatrial septum was classified as a left SP in 37.3%, right SP in 3.3%, and patent foramen ovale (PFO) channel in 3.3%. In 2D-TEE, the interatrial septum was classified as a left SP in 39.3%, right SP in 11.3%, double SP in 4.7%, and PFO channel in 2.0%. The weighted kappa coefficient between MSCT and 2D-TEE in assessing the septum morphology was 0.59. The prevalence of the left SP is lower when it is evaluated by MSCT or 2D-TEE than by anatomical study, but this difference is insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). The prevalence of left SPs is lower when detected by MSCT or 2D-TEE than during autopsy, but the difference is statistically insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). Both 2D-TEE and MSCT are comparable techniques for detecting left-sided SPs with the insignificant lower prevalence of detecting left-sided SPs compared to autopsied material. However, TEE with the contrast seems to be superior over MSCT due to the possibility of unambiguous PFO channel detection. Therefore, TEE with contrast should be preferred over MSCT in the identification of left-sided SPs.

Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents.

BACKGROUND: The aim of this study is to provide a morphometric description of the left-sided septal pouch (LSSP), left atrial accessory appendages, and diverticula using cardiac multi-slice computed tomography (MSCT) and to compare results between patient subgroups. METHODS: Two hundred and ninety four patients (42.9% females) with a mean of 69.4±13.1years of age were investigated using MSCT. The presence of the LSSP, left atrial accessory appendages, and diverticula was evaluated. Multiple logistic regression analysis was performed to check whether the presence of additional left atrial structures is associated with increased risk of atrial fibrillation and cerebrovascular accidents. RESULTS: At least one additional left atrial structure was present in 51.7% of patients. A single LSSP, left atrial diverticulum, and accessory appendage were present in 35.7%, 16.0%, and 4.1% of patients, respectively. After adjusting for other risk factors via multiple logistic regression, patients with LSSP are more likely to have atrial fibrillation (OR=2.00, 95% CI=1.14-3.48, p=0.01). The presence of a LSSP was found to be associated with an increased risk of transient ischemic attack using multiple logistic regression analysis after adjustment for other risk factors (OR=3.88, 95% CI=1.10-13.69, p=0.03). CONCLUSIONS: In conclusion LSSPs, accessory appendages, and diverticula are highly prevalent anatomic structures within the left atrium, which could be easily identified by MSCT. The presence of LSSP is associated with increased risk for atrial fibrillation and transient ischemic attack.

Anthropometry and body composition of adolescents in cracow, poland.

BACKGROUND AND OBJECTIVE: The aim of the present study was to determine the level of adiposity and obesity in Polish adolescents and compare the results with earlier studies conducted in this population as well as those carried out in other populations. METHODS: The study group consisted of 456 boys and 514 girls aged 14-18 years living in Cracow chosen from randomly selected secondary schools. Weight, height, waist, and hip circumference (WC, HC) as well as triceps, biceps, subscapular, and suprailiac skinfold thickness (SFT) were measured. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), subscapular/triceps skinfold ratio (STR), and percentage body fat were computed. The prevalence of overweight and obesity based on Polish children growth reference were calculated and age-dependent and gender-specific smoothed percentile curves for BMI and ROC curves were generated. RESULTS: Weight, height, WC, HC (up 16yr), WHtR (up 15yr), and WHR were considerably higher in males than females. Weight, height, and HC increased with age; WHtR remained the same. The prevalence of overweight and obesity were 10.2% (boys 10.3%; girls 10.1%) and 4.2% (boys 5.3%; girls 3.3%). ROC analysis revealed that WHtR was the best tool for detection of obesity (AUC of 0.982±0.007) in males, whereas the sum of four SFTs (AUC: 0.968±0.011) and WHtR (AUC: 0.963±0.012) were the best predictors of obesity in females. CONCLUSIONS: The level of adiposity in Cracow adolescents increased during the last decade. However, it is still lower than in other well-developed societies struggling with obesity epidemics.