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Periodic Breathing Common in CHF
Periodic breathing during sleep and during exercise appear to be very common in patients with stable heart failure, affecting about half of them, reported Dr. Ugo Corrà of the Salvatore Maugeri Foundation, Veruno, Italy, and associates.
Periodic breathing is an abnormal oscillatory ventilation pattern consisting of cyclic hyperpnea and hypopnea, which can occur in heart failure (HF) patients during sleep or on exertion. Often, the coexistence of the two types of periodic breathing in one patient is hidden from the physician because one type is detected only on exercise testing and the other only in sleep studies.
Dr. Corrà and associates assessed the prognostic value of sleep periodic breathing and exertional periodic breathing in a prospective study of 133 patients with stable, moderate to severe HF as a result of ischemic or idiopathic dilated cardiomyopathy (Circulation 2006;113:44–50).
A total of 67 patients (50%) had some form of periodic breathing: 39 patients (29%) had severe sleep periodic breathing alone, 6 (4%) had exertional periodic breathing alone, and 22 (16%) had both.
During a mean of 3 years of follow-up, 30 patients (23%) died of cardiac causes. Mortality was 9% in patients with no periodic breathing disorders, 17% in those with exertional periodic breathing alone, 31% in those with sleep periodic breathing alone, and 54% in those with both breathing disorders.
Thus, the combination of both sleep and exertional periodic breathing is “a peculiarly ominous condition,” the investigators said.
CRP Doesn't Predict Plaque Burden
C-reactive protein levels appear to be a poor predictor of atherosclerotic plaque burden, reported Dr. Amit Khera of the University of Texas Southwestern Medical Center, Dallas, and associates.
The researchers measured CRP levels in an ethnically diverse, population-based probability sample of subjects aged 30–64 years who were enrolled in a large clinical trial on heart disease. They then assessed correlations between CRP and coronary artery calcification as measured by electron-beam CT in 2,726 of the subjects.
In addition, because not all atherosclerotic plaque is calcified, the investigators examined possible correlations between CRP levels and a novel measure of “soft” plaque—MRI assessment of detectable levels of aortic plaque—in 2,393 subjects.
CRP levels were only modestly associated with atherosclerotic burden, and the correlation was stronger in men than it was in women.
However, this correlation disappeared after the researchers adjusted data for subject age, body mass index, and standard cardiovascular risk factors such as smoking and diabetes (Circulation 2006;113:38–43).
The study results suggest that the link between high CRP levels and incident cardiovascular events “may reflect the composition, morphology, and stability of plaque rather than overall atherosclerotic burden,” they added.
Sizing Up Impact of VTE
More than 900,000 people in the United States experience venous thromboembolism events each year, and a third of these events are fatal, Dr. John A. Heit of the Mayo Clinic, Rochester, Minn., and his colleagues reported in a poster at the annual meeting of the American Society of Hematology.
Using community, hospital, and U.S. census data, the investigators developed an incidence-based model, which estimated that the total annual number of nonfatal venous thromboembolism (VTE) events in the United States is 613,423, including 376,365 cases of deep vein thrombosis (DVT) and 237,058 cases of pulmonary embolism (PE). The estimated annual number of fatal VTE events is 296,370, including 2,258 cases of DVT and 294,112 cases of PE.
Only 7% of VTE-related deaths occur in patients who are diagnosed and treated. More than a third (34%) are a result of sudden, fatal PE, and 59% follow undiagnosed VTE. Two-thirds of VTE events occur in hospitals where safe and effective prophylaxis is available, Dr. Heit noted.
Effective VTE prophylaxis and expert consensus guidelines on the use of prophylaxis are widely available; universal prophylaxis could significantly reduce VTE incidence and related deaths in this country, and its impact deserves further study, the investigators concluded.
Periodic Breathing Common in CHF
Periodic breathing during sleep and during exercise appear to be very common in patients with stable heart failure, affecting about half of them, reported Dr. Ugo Corrà of the Salvatore Maugeri Foundation, Veruno, Italy, and associates.
Periodic breathing is an abnormal oscillatory ventilation pattern consisting of cyclic hyperpnea and hypopnea, which can occur in heart failure (HF) patients during sleep or on exertion. Often, the coexistence of the two types of periodic breathing in one patient is hidden from the physician because one type is detected only on exercise testing and the other only in sleep studies.
Dr. Corrà and associates assessed the prognostic value of sleep periodic breathing and exertional periodic breathing in a prospective study of 133 patients with stable, moderate to severe HF as a result of ischemic or idiopathic dilated cardiomyopathy (Circulation 2006;113:44–50).
A total of 67 patients (50%) had some form of periodic breathing: 39 patients (29%) had severe sleep periodic breathing alone, 6 (4%) had exertional periodic breathing alone, and 22 (16%) had both.
During a mean of 3 years of follow-up, 30 patients (23%) died of cardiac causes. Mortality was 9% in patients with no periodic breathing disorders, 17% in those with exertional periodic breathing alone, 31% in those with sleep periodic breathing alone, and 54% in those with both breathing disorders.
Thus, the combination of both sleep and exertional periodic breathing is “a peculiarly ominous condition,” the investigators said.
CRP Doesn't Predict Plaque Burden
C-reactive protein levels appear to be a poor predictor of atherosclerotic plaque burden, reported Dr. Amit Khera of the University of Texas Southwestern Medical Center, Dallas, and associates.
The researchers measured CRP levels in an ethnically diverse, population-based probability sample of subjects aged 30–64 years who were enrolled in a large clinical trial on heart disease. They then assessed correlations between CRP and coronary artery calcification as measured by electron-beam CT in 2,726 of the subjects.
In addition, because not all atherosclerotic plaque is calcified, the investigators examined possible correlations between CRP levels and a novel measure of “soft” plaque—MRI assessment of detectable levels of aortic plaque—in 2,393 subjects.
CRP levels were only modestly associated with atherosclerotic burden, and the correlation was stronger in men than it was in women.
However, this correlation disappeared after the researchers adjusted data for subject age, body mass index, and standard cardiovascular risk factors such as smoking and diabetes (Circulation 2006;113:38–43).
The study results suggest that the link between high CRP levels and incident cardiovascular events “may reflect the composition, morphology, and stability of plaque rather than overall atherosclerotic burden,” they added.
Sizing Up Impact of VTE
More than 900,000 people in the United States experience venous thromboembolism events each year, and a third of these events are fatal, Dr. John A. Heit of the Mayo Clinic, Rochester, Minn., and his colleagues reported in a poster at the annual meeting of the American Society of Hematology.
Using community, hospital, and U.S. census data, the investigators developed an incidence-based model, which estimated that the total annual number of nonfatal venous thromboembolism (VTE) events in the United States is 613,423, including 376,365 cases of deep vein thrombosis (DVT) and 237,058 cases of pulmonary embolism (PE). The estimated annual number of fatal VTE events is 296,370, including 2,258 cases of DVT and 294,112 cases of PE.
Only 7% of VTE-related deaths occur in patients who are diagnosed and treated. More than a third (34%) are a result of sudden, fatal PE, and 59% follow undiagnosed VTE. Two-thirds of VTE events occur in hospitals where safe and effective prophylaxis is available, Dr. Heit noted.
Effective VTE prophylaxis and expert consensus guidelines on the use of prophylaxis are widely available; universal prophylaxis could significantly reduce VTE incidence and related deaths in this country, and its impact deserves further study, the investigators concluded.
Periodic Breathing Common in CHF
Periodic breathing during sleep and during exercise appear to be very common in patients with stable heart failure, affecting about half of them, reported Dr. Ugo Corrà of the Salvatore Maugeri Foundation, Veruno, Italy, and associates.
Periodic breathing is an abnormal oscillatory ventilation pattern consisting of cyclic hyperpnea and hypopnea, which can occur in heart failure (HF) patients during sleep or on exertion. Often, the coexistence of the two types of periodic breathing in one patient is hidden from the physician because one type is detected only on exercise testing and the other only in sleep studies.
Dr. Corrà and associates assessed the prognostic value of sleep periodic breathing and exertional periodic breathing in a prospective study of 133 patients with stable, moderate to severe HF as a result of ischemic or idiopathic dilated cardiomyopathy (Circulation 2006;113:44–50).
A total of 67 patients (50%) had some form of periodic breathing: 39 patients (29%) had severe sleep periodic breathing alone, 6 (4%) had exertional periodic breathing alone, and 22 (16%) had both.
During a mean of 3 years of follow-up, 30 patients (23%) died of cardiac causes. Mortality was 9% in patients with no periodic breathing disorders, 17% in those with exertional periodic breathing alone, 31% in those with sleep periodic breathing alone, and 54% in those with both breathing disorders.
Thus, the combination of both sleep and exertional periodic breathing is “a peculiarly ominous condition,” the investigators said.
CRP Doesn't Predict Plaque Burden
C-reactive protein levels appear to be a poor predictor of atherosclerotic plaque burden, reported Dr. Amit Khera of the University of Texas Southwestern Medical Center, Dallas, and associates.
The researchers measured CRP levels in an ethnically diverse, population-based probability sample of subjects aged 30–64 years who were enrolled in a large clinical trial on heart disease. They then assessed correlations between CRP and coronary artery calcification as measured by electron-beam CT in 2,726 of the subjects.
In addition, because not all atherosclerotic plaque is calcified, the investigators examined possible correlations between CRP levels and a novel measure of “soft” plaque—MRI assessment of detectable levels of aortic plaque—in 2,393 subjects.
CRP levels were only modestly associated with atherosclerotic burden, and the correlation was stronger in men than it was in women.
However, this correlation disappeared after the researchers adjusted data for subject age, body mass index, and standard cardiovascular risk factors such as smoking and diabetes (Circulation 2006;113:38–43).
The study results suggest that the link between high CRP levels and incident cardiovascular events “may reflect the composition, morphology, and stability of plaque rather than overall atherosclerotic burden,” they added.
Sizing Up Impact of VTE
More than 900,000 people in the United States experience venous thromboembolism events each year, and a third of these events are fatal, Dr. John A. Heit of the Mayo Clinic, Rochester, Minn., and his colleagues reported in a poster at the annual meeting of the American Society of Hematology.
Using community, hospital, and U.S. census data, the investigators developed an incidence-based model, which estimated that the total annual number of nonfatal venous thromboembolism (VTE) events in the United States is 613,423, including 376,365 cases of deep vein thrombosis (DVT) and 237,058 cases of pulmonary embolism (PE). The estimated annual number of fatal VTE events is 296,370, including 2,258 cases of DVT and 294,112 cases of PE.
Only 7% of VTE-related deaths occur in patients who are diagnosed and treated. More than a third (34%) are a result of sudden, fatal PE, and 59% follow undiagnosed VTE. Two-thirds of VTE events occur in hospitals where safe and effective prophylaxis is available, Dr. Heit noted.
Effective VTE prophylaxis and expert consensus guidelines on the use of prophylaxis are widely available; universal prophylaxis could significantly reduce VTE incidence and related deaths in this country, and its impact deserves further study, the investigators concluded.