The quantitative immunoturbidimetric D-dimer method to rule out venous thromboembolism (VTE).

D-dimer measurement is a technique that may improve the diagnostic strategy for venous thrombo-embolism (VTE). To evaluate D-dimer accuracy in the diagnosis of VTE, we identified 116 patients at Charleston Area Medical Center in Charleston, W.Va., for whom D-dimer assay had been performed to screen for VTE. Forty-one had VTE diagnosis confirmed (VTE-Positive); and 75 were ruled out (VTE-Negative); all by radiologic studies. D-dimer values for 41 healthy individuals were also prospectively collected. D-dimer value ranges of VTE-Positive, VTE-Negative and Healthy Sample groups were 0.5-55, 0.5-15.9, and 0.4-3.24 mg/L. Cutoff values of 2.5, 2.1, 1.6, and 1 mg/L had sensitivities of 74%, 81%, 86% and 95%, with specificities of 60%, 48%, 32% and 12%, respectively. Negative predictive values were 80%, 81%, 79% and 82%, while positive predictive values were 52%, 48%, 43% and 39%, respectively. Our results show that quantitative D-dimer assays lack the accuracy to serve as a method for ruling out VTE.

Subendocardial ischemia without coronary artery disease: is elevated left ventricular end diastolic pressure the culprit?

BACKGROUND: The aim was to investigate the association between elevated left ventricular end diastolic pressure (LVEDP) and subendocardial ischemia. METHODS: A retrospective chart review was performed of 1846 consecutive patients admitted between January and September 2002 who had chest pain, stress testing and coronary angiography. RESULTS: 1592 patients were excluded due to a positive coronary angiogram for coronary artery disease (CAD), 254 patients had an angiogram compatible with non-significant CAD and an ejection fraction > 45%; of whom 210 (82.7%) had a positive stress test (study group) and the others 44 (17.3%) had a negative stress test (control group). The mean LVEDP value for the study group (11.8 +/- 6.1 mmHg) was significantly higher than the mean LVEDP value for the control group (7.8 +/- 4.6 mmHg) (p < 0.001). In addition, there were more people with abnormal LVEDP (>or= 12 mmHg) in the study group (n = 103, 49.05%) compared with the control group (n = 10, 22.73%) (p < 0.001). Furthermore, the results of logistic regression revealed that patients with abnormal LVEDP values were 11 times more likely to have had a positive stress test. CONCLUSIONS: There appears to be a positive association between elevated LVEDP and subendocardial ischemia that manifests as a positive stress test in patients without evidence of significant CAD.

Nanobacteria-caused mitral valve calciphylaxis in a man with diabetic renal failure.

We have found that nanobacteria, recently discovered Gram-negative atypical bacteria, can cause local calciphylaxis on the mitral valve in a setting of high-calcium X phosphorous product in the blood. We present the case of a 33-year-old man with diabetic renal failure on continuous ambulatory peritoneal dialysis who died as a result of multiple brain infarcts due to embolizations from mitral valve vegetations. Systemic calciphylaxis was not present. Spectrometric analysis of the mitral valve vegetations showed that they were composed of calcium phosphate, carbonate apatite form, and fibrin. The electron microscopy of the thrombotic vegetation demonstrated nanobacterium as a nidus for carbonate apatite formation. Investigation for the presence of nanobacteria in the multiple organs involved in systemic calciphylaxis may be of help in elucidating the pathogenesis of this frequently fatal disorder.