Growth hormone treatment can provide benefits in body composition, bone, and quality of life in adults with confirmed growth hormone deficiency.

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Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline

Tissue Doppler imaging - A new prognosticator for cardiovascular diseases

BACKGROUND\nB-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes.\n\n\nMETHODS\nWe conducted a prospective, randomized, controlled study of 452 patients who presented to the emergency department with acute dyspnea: 225 patients were randomly assigned to a diagnostic strategy involving the measurement of B-type natriuretic peptide levels with the use of a rapid bedside assay, and 227 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary end points.\n\n\nRESULTS\nBase-line demographic and clinical characteristics were well matched between the two groups. The use of B-type natriuretic peptide levels reduced the need for hospitalization and intensive care; 75 percent of patients in the B-type natriuretic peptide group were hospitalized, as compared with 85 percent of patients in the control group (P=0.008), and 15 percent of those in the B-type natriuretic peptide group required intensive care, as compared with 24 percent of those in the control group (P=0.01). The median time to discharge was 8.0 days in the B-type natriuretic peptide group and 11.0 days in the control group (P=0.001). The mean total cost of treatment was 5,410 dollars (95 percent confidence interval, 4,516 dollars to 6,304 dollars) in the B-type natriuretic peptide group, as compared with 7,264 dollars (95 percent confidence interval, 6,301 dollars to 8,227 dollars) in the control group (P=0.006). The respective 30-day mortality rates were 10 percent and 12 percent (P=0.45).\n\n\nCONCLUSIONS\nUsed in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide in the emergency department improved the evaluation and treatment of patients with acute dyspnea and thereby reduced the time to discharge and the total cost of treatment.

Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea

Background Readmission after heart failure (HF) hospitalization is an increasing focus for physicians and policy makers, but statistical models are needed to assess patient risk and to compare hospital performance. We performed a systematic review to describe models designed to compare hospital rates of readmission or to predict patients' risk of readmission, as well as to identify studies evaluating patient characteristics associated with hospital readmission, all among patients admitted for HF. Methods We identified relevant studies published between January 1, 1950, and November 19, 2007, by searching MEDLINE, Scopus, PsycINFO, and all 4 Ovid Evidence-Based Medicine Reviews. Eligible English-language publications reported on readmission after HF hospitalization among adult patients. We excluded experimental studies and publications without original data or quantitative outcomes. Results From 941 potentially relevant articles, 117 met inclusion criteria: none contained models to compare readmission rates among hospitals, 5 (4.3%) presented models to predict patients' risk of readmission, and 112 (95.7%) examined patient characteristics associated with readmission. Studies varied in case identification, used multiple types of data sources, found few patient characteristics consistently associated with readmission, and examined differing outcomes, often either readmission alone or a combined outcome of readmission or death, measured across varying periods (from 14 days to 4 years). Two articles reported model discriminations of patient readmission risk, both of which were modest (C statistic, 0.60 for both). Conclusions Our systematic review identified no model designed to compare hospital rates of readmission, while models designed to predict patients' readmission risk used heterogeneous approaches and found substantial inconsistencies regarding which patient characteristics were predictive. Clinically, patient risk stratification is challenging. From a policy perspective, a validated risk-standardized statistical model to accurately profile hospitals using readmission rates is unavailable in the published English-language literature to date.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/414374/ira80003_1371_1386.pdf

Statistical models and patient predictors of readmission for heart failure: a systematic review

Inflammatory biomarkers in coronary artery disease.

Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration

The aim of this study was to investigate the impact of obstructive sleep apnea (OSA) on left ventricular (LV) functional changes by using tissue Doppler imaging-derived indexes in patients with OSA. We studied 62 patients classified into 3 groups, namely 18 with mild to moderate OSA, 24 with severe OSA, and 20 control subjects without OSA according to the apnea-hypopnea index (AHI) on complete overnight polysomnogram. All underwent conventional and tissue Doppler echocardiographies. Only early diastolic velocity (Ea; -6.2 +/- 0.3 vs -7.1 +/- 0.3 vs -7.3 +/- 0.3 cm/s, respectively, for the 3 groups, p = 0.023) was significantly decreased in the severe OSA group. Other echocardiographic parameters of diastolic function such as isovolumic relaxation time, deceleration time, mitral inflow early/late wave velocity ratio, and pulmonary vein systolic/diastolic pulmonary vein velocity ratio were comparable among the 3 groups. AHI was correlated only with tissue Doppler imaging-derived indexes of LV diastolic function (Ea r = -0.382, p = 0.002; Ea/late diastolic velocity r = -0.329, p = 0.009), but not with conventional Doppler indexes. AHI remained a significant predictor of Ea after adjusting for age, heart rate, fasting glucose level, blood pressure, body mass index, and LV mass index in a multiple stepwise linear regression model (p = 0.007). In conclusion, only patients with severe OSA showed a greater impairment of LV diastolic function. Of all echocardiographic parameters of diastolic dysfunction investigated, only Ea was identified as the best index to demonstrate an association between LV diastolic dysfunction and severity of OSA independently of body mass index, diabetes mellitus, and hypertension.

Impact of obstructive sleep apnea on left ventricular diastolic function.

https://www.internationaljournalofcardiology.com/article/S0167-5273(08)00957-1/pdf

Left atrial dyssynchrony assessed by strain imaging in predicting future development of atrial fibrillation in patients with heart failure.

Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography.

Experimental studies have demonstrated KLOTHO gene polymorphism might be associated with vascular atherosclerosis and calcification However, the impact of this genetic variant on human coronary arteries still remains to be elucidated We investigated the effect of a KLOTHO gene variant on coronary artery stenosis and calcification Four hundred and thirty-four patients referred for chest pain were enrolled All the patients underwent coronary angiography and were investigated for polymorphism of the KLOTHO G395A gene Coronary artery disease (CAD) was defined as > or = 50% diameter stenosis in at least one coronary artery The other patients were considered to be controls Homozygotes or heterozygotes for G395A were significantly more common in the CAD patients than in the controls (302% versus 215%, P = 0039) In the subgroup aged or = 60 years, there was no difference (280% versus 241%, P = 0473) Using multivariate analysis, we identified the KLOTHO gene G395A mutant as an independent risk factor of CAD (OR 1712, 95% CI [1066-2749], P = 0026) The frequency of the KLOTHO gene G395A mutant was not different between the calcified and noncalcified coronary artery groups (257%, 264%, respectively, P = 0861) and an A allele carrier state was not an independent risk factor of coronary artery calcification In conclusion, the KLOTHO gene G395A allele carrier state may be associated with CAD but not with coronary artery calcification in this Korean population

Goo Yeong Cho

Papers

Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration

Impact of obstructive sleep apnea on left ventricular diastolic function.

Left atrial dyssynchrony assessed by strain imaging in predicting future development of atrial fibrillation in patients with heart failure.

Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography.

KLOTHO gene polymorphism is associated with coronary artery stenosis but not with coronary calcification in a Korean population.