...the patient's ability to estimate his own daily "working" capacity seems to carry a higher prognostic value than that estimated from repeat functional exercise testing. ...1-year changes in peak ...aerobic capacity may still have a prognostic value in patients with HF.
MRI and PET with 18F-fluoro-ethyl-tyrosine (FET) have been increasingly used to evaluate patients with gliomas. Our purpose was to assess the additive value of MR spectroscopy (MRS), diffusion ...imaging and dynamic FET-PET for glioma grading.
38 patients (42 ± 15 aged, F/M: 0.46) with untreated histologically proven brain gliomas were included. All underwent conventional MRI, MRS, diffusion sequences, and FET-PET within 3±4 weeks. Performances of tumour FET time-activity-curve, early-to-middle SUVmax ratio, choline / creatine ratio and ADC histogram distribution pattern for gliomas grading were assessed, as compared to histology. Combination of these parameters and respective odds were also evaluated.
Tumour time-activity-curve reached the best accuracy (67%) when taken alone to distinguish between low and high-grade gliomas, followed by ADC histogram analysis (65%). Combination of time-activity-curve and ADC histogram analysis improved the sensitivity from 67% to 86% and the specificity from 63-67% to 100% (p < 0.008). On multivariate logistic regression analysis, negative slope of the tumour FET time-activity-curve however remains the best predictor of high-grade glioma (odds 7.6, SE 6.8, p = 0.022).
Combination of dynamic FET-PET and diffusion MRI reached good performance for gliomas grading. The use of FET-PET/MR may be highly relevant in the initial assessment of primary brain tumours.
Background Both heart and renal failure are characterised by increased systemic oxidative stress and endothelial dysfunction and occur in the cardiorenal syndrome (CRS). The aim of the present study ...was to assess the impact of N-acetylcysteine (NAC), a potent antioxidant, on endothelial function, B-type natriuretic peptide (BNP) and renal function in patients with CRS. Methods In a double blind, placebo controlled manner, we randomised nine stable outpatients with both heart failure (LVEF < 40% and NYHA class II or III) and renal failure (Cockroft Gault clearance of 20–60 ml/min) to placebo or NAC (500 mg orally twice daily) for 28 days followed by a wash out period (>7 days) and crossover to the other treatment. Results Eight patients completed the study and all data ( N = 9) was used in the analysis. Mean forearm blood flow improved significantly with NAC with mean ratio of improvement of 1.99 (SEM: ±0.49) for NAC and 0.73 (SEM: ±0.23) for placebo with a p -value of 0.047. There was no significant difference in BNP ( p = 0.25), renal function ( p = 0.71) or NYHA class ( p = 0.5). No deaths occurred during the trial. Conclusion In this pilot trial of patients with CRS, NAC therapy was associated with improved forearm blood flow. This may represent a general improvement in endothelial function and warrants further investigation of antioxidant therapy in these patients.
Abstract Background Cardiopulmonary exercise testing is the method of choice for the differentiation of exercise intolerance. This study sought to assess the utility of B-type natriuretic peptide ...(BNP) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) for the identification of a cardiocirculatory exercise limitation. Methods In 162 patients undergoing cardiopulmonary exercise testing, rest and peak exercise BNP and NT-proBNP levels were measured. In 94 patients fulfilling criteria for appropriate effort and sufficient diagnostic certainty, the accuracy of BNP and NT-proBNP for the prediction of a cardiocirculatory limitation, as assessed based on clinical and exercise testing data, was determined. Results A cardiocirculatory limitation was identified in 27 (29%) patients. Median (interquartile range) resting BNP 162 (45-415) vs 39 (19-94) vs 24 (15-46) pg/mL; P <.001 and NT-proBNP 506 (129-1167) vs 77 (35-237) vs 34 (19-77) pg/mL; P <.001 were higher in patients with cardiocirculatory as compared with those with pulmonary limitation (n = 28) and those without cardiocirculatory or pulmonary limitation (n = 39). The area under the receiver operator characteristics curve for BNP and NT-proBNP to identify a cardiocirculatory limitation was 0.79 and 0.84, respectively ( P = .15 for comparison of the curves). Sensitivity and specificity of the optimal BNP cutoff of 85 pg/mL were 63% and 84%, respectively. Sensitivity and specificity of the optimal NT-proBNP cutoff of 223 pg/mL were 74% and 85%, respectively. Peak exercise biomarkers were not more accurate than resting levels. Conclusions Among patients referred for cardiopulmonary exercise testing for evaluation of unexplained exercise intolerance, BNP and NT-proBNP were similarly useful to identify those with a cardiocirculatory limitation.
A 62-year-old man presenting with congestive heart failure due to a fistula between an aortic pseudoaneurysm and the right pulmonary artery is described. The shunt occurred 4 years after aortic valve ...and supracoronary graft replacement and was diagnosed by transesophageal contrast echocardiography. After redo surgery the patient made an uneventful recovery.
Highlights • Recurrent events are common in patients with heart failure, though hardly analyzed • Recurrent events may reveal effects not seen by time-to-first event analysis • Gap-time method may be ...helpful to analyses recurrent events
Abstract We present a 44-year-old man with invasive aortic and tricuspid valve endocarditis complicated by electrical storm, which was immediately diagnosed and successfully treated due to the ...patient's telemetry electrocardiogram (ECG). This case highlights a rare but potentially fatal complication in patients with invasive endocarditis and the need for very careful clinical evaluation and monitoring of these patients.
PDF
