Open Access e-Journal Cardiometry No.16 May 2020

More documents

Recommendations

Info

patients (42.6%) had grade 2 definite angina. ConsideringMPI results, 297 patients had normal results, 144(24.6%), 54 (9.2%), 60 (10.3%) and 30 patients (5.1%)had mild ischemia, moderate ischemia, severe ischemiaand no perfusion respectively.In our study, among diabetic patients 198 (67.3%) ofthem were women and 96 (32.7%) of them were men.Mean diabetic patients age was 58.89 years. There were177 (60.8%) women and 114 (39.2%) men within nondiabetic patients. Mean age of non-diabetic patientswas 57.76 years. Based on performed analysis there wasno significant difference between diabetic and non-diabeticpatients based on gender (P-value-0.1) and age(P-value=0.2). table No.1 below shows descriptive statisticsassociated with patient’s gender and age.In this study 80.6% of diabetic patients had HTNand 55.7% of non-diabetic patients had HTN. With aP-value of 0.001 it means that diabetic patients had asignificantly higher rate of HTN. table No.2 shows theassociation between DM and HTN in our study.Our results show that there is also a significant associationbetween history of ischemia and diabetes.Association between DM and history of ischemia issummed up in table No.3.Chi-square analysis results indicate that there isa statistically significant difference between diabeticand non-diabetic patients in terms of abnormalities ofMPI. As also seen in table No.4, 62.9% of non-diabeticpatients had normal MPI and only 38.8% of diabeticpatients had normal MPI results.As seen in table No.5 below our results indicate thatthere is no statistically significant difference betweendiabetic and non-diabetic patients based on their RAS(P-value=0.93).Remembering main goal of our research which was toevaluate any possible association between RAS and MPIabnormality, we separately analyzed our data for this associationin both diabetic and non-diabetic patients. Asseen in table No.6, there is a significant association betweenRAS and MPI abnormality in diabetic patients.Our findings show the same significant associationbetween RAS and MPI findings in non-diabetic patientstoo (P-value=0.001). The results are summed upin table No.7.DiscussionThere are 200 million people living with diabetesaround the world. Risk of cardiovascular involvementin diabetic patients in 2 to 4 times more than non-diabeticpopulation (18, 19). In European and Americanguidelines DM is considered equal to cardiovascularinvolvement. Prevalence of coronary artery diseasesamong diabetic patients has been reported to be 43 to53% regardless of gender (19). Considering high qualityand value of MPI along with lack of accessibility forall patients and high expenses, in this study we decidedto see if simple RAS questionnaire can be associatedwith MPI findings in diabetic and non-diabeticpatients or not.In this study we found that there is a statistically significantassociation between MPI findings and RAS inboth diabetic and non-diabetic patients. There was a significantcorrelation between HTN and history of ischemiawith DM. our both diabetic and non-diabetic populationswere not different based on age, gender or RAS.In a study performed in Iran by Habibian et al., regressionanalysis results showed a positive and powerfulcorrelation between RAS and HTN, DM, smokingand gender (20). Other similar studies also showedthe same results (21). Our study was a bit different becausethey investigated general population but we enrolledsusceptible patients with angina pectoris whichwere going to undergo MPI.A large population of 6498 patients above 35 yearsold were studied by Sadeghi et al. and researchers reportedthat prevalence of coronary artery disease was37.5% in women and 22.2% in men based on RASquestionnaire. They found that prevalence of coronaryartery disease increases by age. They also reported thatdocumented myocardial infarction based on electrocardiogramis recorded higher in men compared towomen but the prevalence based on RAS was higherin women in all age groups (22).Poudel et al. investigated 100 patients with chestpain referred to emergency department. They foundthat RAS questionnaire possess 63.8% true positive and33.3 true negative for diagnosis of MI. true positive MIcases after cardiology consult was reported to be 71.6%which indicates reliability of Rose questionnaire (23).In a comprehensive study performed by Hui et al.on 1957 patients with coronary artery disease, 619 ofthem were diabetic. They found that there is no significantdifference between diabetic and non-diabeticpatients based on their RAS questionnaire which is inaccordance with our results (24).Another similar study performed by Rahman et al.showed that history of HTN and myocardial ischemiain diabetic patient is significantly higher in compar-114 | Cardiometry | Issue 16. May 2020
ison to non-diabetic patients but similar to presentstudy, RAS was not significantly different between diabeticand non-diabetic patients(14).It seems that performing an appropriate screeningbefore MPI can reduce number of unnecessary scans.This risk assessment method seems to be useful in diabeticpatients with higher risk of silent ischemia too.Park et al. revealed that risk RAS questionnaire issimilar to coronary CT angiography in risk assessmentof coronary artery diseases. Their study also indicatedthat DM, HTN, family history and history of previousischemia is significantly correlated with severity ischemia(25) ar.Considering all mentioned above findings, it seemsthat although MPI is a really powerful and acceptablemodality but it still cannot be completely replacedwith physical examination, history taking and clinicaljudgement of physicians. By this study we did notwant to deny usefulness and high value of MPI but wewanted to attract attention and focus on clinical judgement.We believe that by having appropriate medicalknowledge and a good clinical insight, physicians canget even better results out of paraclinical modalities.ConclusionOur results showed that RAS is associated with severityof perfusion defect detected via MPI. We concludethat in patients with high risk angina pectorissuch as diabetic patients, hypertensive patients andpatients with history of previous ischemia, by meansof appropriate use of RAS, it is possible to avoid unnecessaryMPI.We do not claim that RAS is a more powerful toolfor assessment of coronary artery disease compared toMPI, but we think that a good clinical judgement andinsight can avoid unnecessary expenses and can leadto a better application of imaging modalities.Statement on ethical issuesResearch involving people and/or animals is in fullcompliance with current national and internationalethical standards.Conflict of interestNone declared.Author contributionsThe authors read the ICMJE criteria for authorship andapproved the final manuscript.References1. Nichols M, Townsend N, Scarborough P, RaynerM. Cardiovascular disease in Europe: epidemiologicalupdate. European heart journal. 2013;34(39):3028-34.2. Deaton C, Froelicher ES, Wu LH, Ho C, ShishaniK, Jaarsma T. The global burden of cardiovasculardisease. European Journal of Cardiovascular Nursing.2011;10(2_suppl):S5-S13.3. Kannel WB, McGee DL. Diabetes and cardiovascularrisk factors: the Framingham study. Circulation.1979;59(1):8-13.4. Kannel WB. Blood pressure as a cardiovascular risk factor:prevention and treatment. Jama. 1996; 275(20): 1571-6.5. Grundy SM. Metabolic syndrome: a multiplex cardiovascularrisk factor. The Journal of Clinical Endocrinology& Metabolism. 2007;92(2):399-404.6. Bateman TM. Advantages and disadvantages of PETand SPECT in a busy clinical practice. Journal of NuclearCardiology. 2012;19(1):3-11.7. Sabharwal NK, Stoykova B, Taneja AK, Lahiri A.A randomized trial of exercise treadmill ECG versusstress SPECT myocardial perfusion imaging as an initialdiagnostic strategy in stable patients with chestpain and suspected CAD: cost analysis. Journal of nuclearcardiology. 2007;14(2):174.8. Garcia EV, Cooke CD, Folks RD, Santana CA, KrawczynskaEG, De Braal L, et al. Diagnostic performanceof an expert system for the interpretation of myocardialperfusion SPECT studies. Journal of Nuclear Medicine.2001;42(8):1185-91.9. Go RT, Marwick TH, MacIntyre WJ, Saha GB, NeumannDR, Underwood DA, et al. A prospective comparisonof rubidium-82 PET and thallium-201 SPECTmyocardial perfusion imaging utilizing a single dipyridamolestress in the diagnosis of coronary artery disease.Journal of nuclear medicine: official publication,Society of Nuclear Medicine. 1990;31(12):1899-905.10. Verani MS. Myocardial perfusion imaging versustwo-dimensional echocardiography: comparative valuein the diagnosis of coronary artery disease. Journalof Nuclear Cardiology. 1994;1(4):399-414.11. Otsuka R, Miyazaki Y, Kubo N, Kawahara M, TakaesuJ, Fukuchi K. The Status of Stress MyocardialPerfusion Imaging Using 99mTc Pharmaceuticals inJapan: Results from a Nationwide Survey. Asia OceaniaJournal of Nuclear Medicine and Biology. 2018;6(2):90.12. Gaziano TA. Cardiovascular disease in the developingworld and its cost-effective management. Circulation.2005;112(23):3547-53.Issue 16. May 2020 | Cardiometry | 115
Page 1 and 2:
124 | Cardiometry | Issue 16. May 2
Page 3 and 4:
Dear Reader!Our life dictates what
Page 5 and 6:
Prof. Mohammad AleemCairo Universit
Page 7 and 8:
74808597The study of hemodynamics i
Page 9 and 10:
We commemorate great Russian scient
Page 11 and 12:
and, in particular, activated is th
Page 13 and 14:
decline in the rate of those who fo
Page 15 and 16:
Table 1.Mass parameters of some org
Page 17 and 18:
REVIEW Submitted: 20.02.2020; Accep
Page 19 and 20:
teides. As a rule, under the hypoxi
Page 21 and 22:
Table 1Changes in ratios between th
Page 23 and 24:
Consequences of anaerobic formation
Page 25 and 26:
receptor SUCNR1 [72], which is call
Page 27 and 28:
acid and oxalacetic acid. J. Biol.
Page 29 and 30:
Issue 16. May 2020 | Cardiometry |
Page 31 and 32:
12], we may assume that PC-assisted
Page 33 and 34:
Figure 2. Demonstration of the para
Page 35 and 36:
of doubts has been expressed by tho
Page 37 and 38:
ORIGINAL RESEARCH Submitted: 2.04.2
Page 39 and 40:
Table 2. Dependence of SHD profile
Page 41 and 42:
Figure 4Figure 5Figure 6 Figure 7Ta
Page 43 and 44:
The mapping between the SHD profile
Page 45 and 46:
Issue 16. May 2020 | Cardiometry |
Page 47 and 48:
measurement thereof cannot detect a
Page 49 and 50:
AimsThe aim of this study is to ass
Page 51 and 52:
vascular system condition, using an
Page 53 and 54:
4. Papers devoted to the AH treatme
Page 55 and 56:
2019;2(12):18-23. https://doi.org/1
Page 57 and 58:
ORIGINAL RESEARCH Submitted: 17.01.
Page 59 and 60:
The statistical analysis of the obt
Page 61 and 62:
Table 7Eigenvalues and percentage o
Page 63 and 64:
but also as a means for active mode
Page 65 and 66: values [6]. Both groups are homogen
Page 67 and 68: Table 2No. of ind.BMIAge, yearsHb,
Page 69 and 70: ORIGINAL RESEARCH Submitted: 18.03.
Page 71 and 72: а) b)Figure 1. Fragments of the bl
Page 73 and 74: а)b)cd)Figure 3. Fragments of seru
Page 75 and 76: zation of the facias and add to the
Page 77 and 78: PV5 - blood volume (part of SV), pu
Page 79 and 80: Conflict of interestNone declared.A
Page 81 and 82: Issue 16. May 2020 | Cardiometry |
Page 83 and 84: the action of high level energy. Ac
Page 85 and 86: Figure 5. Diagram of “a multipuls
Page 87 and 88: REPORT Submitted: 25.02.2020; Accep
Page 89 and 90: used to suppress this sort of noise
Page 91 and 92: tion v[n] using HFF, then the final
Page 93 and 94: jω jω jωZe ( ) = Xe ( ) H1( e )
Page 95 and 96: Figure 4. Filtering of the ECG sign
Page 97 and 98: Significant data have been obtained
Page 99 and 100: REVIEW Submitted: 5.03.2020; Accept
Page 101 and 102: companies have even made the implem
Page 103 and 104: the evaluation of the item occurs.
Page 105 and 106: XFig.1. Medical recommender system
Page 107 and 108: System Using Collaborative Filterin
Page 109 and 110: processing analysis, in particular
Page 111 and 112: Statement on ethical issuesResearch
Page 113 and 114: ORIGINAL RESEARCH Submitted: 12.01.
Page 115: Table 1Descriptive statistics of pa
Page 119 and 120: ORIGINAL RESEARCH Submitted: 4.12.2
Page 121 and 122: The data have been collected and th
Page 123 and 124: It is known that the main mechanism
show all

Open Access e-Journal Cardiometry No.16 May 2020

Create successful ePaper yourself

Delete template?

Save as template?