Appropriateness of ECG Holter requests in an outpatient service: a prospective study.

BACKGROUND: Electrocardiographic ambulatory ECG monitoring plays a central role in the diagnostic evaluation of patients with cardiac arrhythmias. We sought to evaluate the appropriateness of the prescription of ECG Holter recordings performed at our centre. METHODS: We interviewed 2489 consecutive patients (49% male, aged 61 +/- 32 years) undergoing ECG Holter. We recorded the indication for the examination, the clinical characteristics of the patient and the speciality of the prescribing physician. The appropriateness of the test was evaluated. RESULTS: We evaluated 2489 consecutive Holter recordings, of which 1298 (52%) were found to have been clearly appropriate (class I), 311 (13%) as probably or possibly appropriate (class II), and 880 (35%) as inappropriate (class III). The test was requested by a cardiologist in 776 cases (31%), of which 56.2% had a class I indication, 13.4% class II, and 30.4% class III. Tests requested by a non-cardiologist were clearly appropriate (class I) in 50% of cases, whereas 12% had a class II indication, and 38% were in class III. Supraventricular tachycardia was present in 33.4% of recordings with a class I indication, 9% of those in class II, and 57.6% of those in class III. Non-sustained ventricular tachycardia was present in 6% of those with class I indications, 2.6% of those in class II, and 7.4% of those in class III. CONCLUSION: Our data showed that the majority of Holter recordings prescribed in our region are appropriate. Tests prescribed by cardiologists constitute only 31% of the total volume, but are more often appropriately prescribed.

Cytotoxin-associated gene-A--positive Helicobacter pylori strains are associated with atherosclerotic stroke.

BACKGROUND: It is uncertain whether Helicobacter pylori is associated with ischemic syndromes and whether this association is mediated by the induction of atherosclerosis. In this study, we tested the hypothesis that atherosclerotic stroke shows a selective association with virulent H pylori strains. METHODS AND RESULTS: The seroprevalence of infection by H pylori and by strains bearing the cytotoxin-associated gene-A (CagA), a strong virulence factor, was assessed by ELISA in 138 patients with large-vessel stroke (group A), in 61 patients with cardioembolic stroke (group B), and in 151 healthy control subjects. The 3 groups had a similar socioeconomic status. Serum levels of C-reactive protein were also measured by ELISA. The prevalence of infection was 71% in group A, 63.9% in group B, and 70.2% in the control group (P=NS), whereas the prevalence of CagA-positive strains was higher in group A than in group B (42.8% versus 19.7%, respectively; odds ratio 3.04, 95% CI 1.43 to 6.49; P<0.001) and higher in group A than in the control group (42.8% versus 17.9%, respectively; odds ratio 4.3, 95% CI 2.12 to 8.64; P<0.001), after adjusting for main cardiovascular risk factors and social class. A trend toward a difference in C-reactive protein was observed between CagA-positive (2.00+/-3.43 [mean+/-SD] mg/dL) and CagA-negative (1.31+/-1.72 [mean+/-SD] mg/dL) patients (P=0.072, Mann-Whitney U test). CONCLUSIONS: The association between H pylori and acute cerebrovascular disease seems to be due to a higher prevalence of more virulent H pylori strains in patients with atherosclerotic stroke.