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Showing posts with label stress test. Show all posts
Showing posts with label stress test. Show all posts

Tuesday, February 10, 2015

Coronary Calcium Imaging Improves on Framingham Score Regardless of Symptoms in Analysis - Medscape

Coronary Calcium Imaging Improves on Framingham Score Regardless of Symptoms in Analysis

HOUSTON, TX — In asymptomatic and symptomatic patients at low risk for coronary artery disease, the use of coronary artery calcium (CAC) imaging improves long-term prediction of risk beyond that established by the Framingham Risk Score (FRS) and exercise-treadmill and stress-perfusion testing, according to the results of a new study[1]. The same findings were observed even among individuals who met the appropriate-use criteria for functional testing, report investigators.
"What we were able to show was that across all Framingham Risk Scores, calcium scoring significantly added in terms of predicting outcome and reclassifying risk in these individuals," senior investigator Dr John Mahmarian (Houston Methodist DeBakey Heart and Vascular Center, TX) told heartwire . "There have been several studies looking at low Framingham Risk Score patients, and this study bolsters the argument that calcium scoring adds tremendously in that [low-risk] group."
Furthermore, the researchers also looked at several treadmill variables—peak-exercise capacity, exercise-tolerance test (ETT) ischemia, and the Duke treadmill score—and found the addition of the calcium score to any of the variables significantly improved the reclassification of risk beyond that achieved with the clinical-data and functional-test results.
The results of the study, which was led by Dr Su Min Chang (Houston Methodist DeBakey Heart and Vascular Center), are published February 9, 2015 in JACC: Cardiovascular Imaging.

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Read the complete article here.

Friday, August 9, 2013

The angioplasty and stent of President George W. Bush - Dayspring

Commentary regarding the angioplasty and stent of President George W. Bush           
Commentary from Thomas Dayspring MD, FACP, FNLA regarding the angioplasty and stent of President George W. Bush 
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George W. Bush underwent stent placement because during a routine physical a stress test (which is rarely indicated in an asymptomatic person) revealed an abnormality that led to a CT-angiogram test (which is rarely indicated in an asymptomatic person) that led to a coronary angiogram test (which is rarely indicated in an asymptomatic person) that as usual led to a stent (which is rarely indicated in an asymptomatic person). Why was an angiogram done on an asymptomatic person? Did the test show early marked ST depression that suggested a main stem lesion? There is a bit of a history here – all public knowledge. During his second year in office during a yearly physical at Bethesda his physician did a routine coronary calcium level which was 4 (trivial). Even though his LDL-C was fine (~100 mg/dL superb by 2001 standards) they started him on a statin and as one would suspect, a low fat diet. It is well known what a super exercise routine Mr. Bush pursues (then and now): secret service men cannot keep up with him on jogs or bike rides. Now we find out that he suddenly needed a stent. Well do not clogged pipes; I mean arteries – need plumbers to fix them? And is it not dietary fat and cholesterol that clogs the arteries? For more opinions on the inappropriateness of the workup please see  http://www.theheart.org/article/1567069.do
 
Earlier in the year I posted a commentary on LecturePad.org regarding “Clogged Arteries.” (click here to review) That posting was provoked by a perspective authored by Michael Rothberg of the Cleveland Clinic which was published in Circulation Cardiovascular Quality Outcomes. (Circ Cardiovasc Qual Outcomes. 2013;6:129-132) entitled Coronary Artery Disease as Clogged Pipes A Misconceptual Model. It is a brilliant piece and needs to be read by all providers including Mr. Bush’s physicians. Here are some of the many highlights verbatim from that perspective ....
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Read the complete article here.

I also recommend The Doc's Opinion on President Bush here.

Listen to podcast by Dr. William Blanchet here.