心血管疾患と診断

Background: The huge amounts of data generated by healthcare transactions are complex and voluminous. They need to be processed and analysed by different traditional methods. Data Mining provides the methodology and technology to transform these amounts of data into useful information for decision making. Cardiovascular diseases are one of the highest-flying diseases of the modern world. The treatment of the said disease is quite high and not affordable by most of the patients particularly in India. To solve this problem, Data Mining is the best available technique for classification and prediction.
Aim: Research work was aimed to analyse the various data mining techniques introduced in recent years to design a predictive model for cardiovascular diseases from the data obtained by transthoracic echocardiography.
Methods: A total of 336 records with 24 attributes were highly relevant in predicting heart disease from echocardiography dataset were analysed by applying techniques prospectively. This study investigates three different classification models: J48 Decision Tree, Naive Bayes and Neural Network on cardiovascular disease prediction and the same has been justified with the results of different experiments conducted and the performance of the models was evaluated using the standard metrics of Accuracy, Precision, Recall and F-measure.
Discussion and Conclusion: The results of all the three algorithms performed best in true negative rate which makes it a handy tool to train medical students and junior cardiologists to diagnose patients with heart disease.

Background: The etiology of syncope in young adults is poorly defined and most studies reveal benign etiologies. However, case reports suggest that exercise-related syncope, even in young patients, can be a harbinger of sudden cardiac death. We aim to determine the characteristics of young adults presenting with syncope in a diverse population of navy recruits.
Methods: A retrospective chart review was performed on all Navy recruits who presented with a complaint of syncope to the Captain James A. Lovell Federal Health Care Center (JALFHCC) between June 1, 2006 and May 31, 2013. There was a total of 154 charts. Demographics and clinical data, along with Electrocardiogram (EKG), telemetry, and echocardiographic findings were recorded. Variables were compared between the subjects with abnormal cardiac profile and subjects with normal cardiac results.
Results: The sample size of 154 included 95 males and 59 females. There were 13 (8.4%) subjects who were found to have concerned cardiac findings; 9 were males (9.5% of males) and 4 were females (6.8% of females). Compared to those without cardiac findings, there were no significant differences in age (20.2 ± 3.8 vs. 20.2 ± 2.5 years), body mass index (25.8 ± 2.8 vs. 24.7 ± 3.5), prior history of syncope (23 vs. 21%), or presence of exertional syncope (77 vs. 63%).
Conclusion: A significant proportion of young American navy recruits have evidence of concerning electro and echocardiographic findings. We did not find any clinical profile predicting such findings although there was a statistically insignificant, but noticeable trend towards exertional syncope in those who had concerning cardiac abnormalities.

In the last two decades there has been an enormous step forward in the diagnosis and therapeutic interventions (TI) in foetuses with congenital heart anomalies. Prenatal diagnosis and therapy not only require many professional skills, but entails many ethical and legislative consequences, causing a critical attitude. Therefore, the experts dealing with fetology are obliged to present their results, no matter what they are, because only in this way the contribution to the development and proper understanding of the concept could be made. Understanding the natural history of the malformation and the continual ability to refine patient selection are critical for possible TI.

Though it is established that certain primary tumours of the heart may be present in infancy, little information is available recommending best practice for various surgical issues that may present during the first week of life. We report a very unusual intra-cardiac tumour presentation with challenges both clinically and pathologically.

Coronary artery disease (CAD) is a very common cause of morbidity and is the leading cause of death in adults, accounting for one-third of all deaths in subjects over age 35. Catheter coronary angiography (CCA) has been the gold standard in the diagnosis and management of CAD. Over the last few years, Coronary CT angiography (CCTA), a non-invasive test is being adopted by positive evidence and usability for low-medium pre-test probability for CAD.

Background: The main goal of chemotherapy is to destroy tumor cells at the maximum with minimal damage to healthy tissue, which is sometimes difficult to achieve due to the non-selectivity of chemotherapeutics. Cardiotoxicity become important in the past several years, as significant progress has been made in both, early diagnosis and the use of increasingly advanced antitumor drugs. The aim of this study was to establish the frequency of cardiotoxicity in the patients treated with the first-line chemotherapy (gemcitabine and cisplatin vs paclitaxel and carboplatin).

Methods: This prospective study included 240 non-small cell lung cancer patients at the clinical stages III and IV. Patients are divided into groups according to the type of chemotherapy (gemcitabine and cisplatin versus paclitaxel and carboplatin) and cardiovascular co-morbidities. Physical examination, electrocardiogram and NTproBNP (Nterminal proBrain Natriuremic Peptide) and troponin T levels were performed before and after the application of each cycle of chemotherapy. Echocardiography was performed before and after chemotherapy, as well as in the follow-up examinations every three months, a total of one year. Cardiac toxicity was determined based on the presence of cardiovascular symptoms, changes in the electrocardiogram, elevated levels of NTproBNP and troponin T and a decrease in left ventricular ejection fraction.

Results: In the study 184 patients (76.7%) were male. The most frequent was adenocarcinoma, in 120 patients (50%). Most common cardiovascular toxic effects were elevation in the level of NTproBNP (44.85%), cardiac arrhythmias (26.18%), venous thromboembolism (19.9%) and decreased left ventricular ejection fraction (6.96%). Patients treated with the first-line chemotherapy gemcitabine and cisplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, but without statistical significance. In the group with paclitaxel and carboplatin, patients developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, and the statistical significance was registered at the first follow-up examination in stage III NSCLC patients (p=0.037).

Conclusion: Chemotherapy induced cardiotoxicity frequently occurs in patients with cardiovascular comorbidities. Early detection and adequate therapy of cardiotoxicity is crucial for substantial recovery of cardiac function. Balance between the effectiveness of chemotherapy and the risk of cardiotoxicity requires close cooperation oncologists and cardiologists.

The three primary or ‘elementary’ coronary arteries and their branches perfuse the heart and originate from the sinuses of Valsalva. Generally, the right coronary artery (RCA) originates from the upper or middle third of the right anterior sinus of Valsalva. It gives rise to the conus branch, one or more acute marginal branches, and if we are talking about right dominant circulation forms the AV nodal artery, the posterior descending artery (PDA) and posterolateral branches. In turn, the left coronary artery originates above the upper or middle third in the left anterior sinus of Valsalva. The left anterior descending artery gives rise to septal branches that curve down into the interventricular septum and diagonal branches that wrap over the anterolateral free wall of the left ventricle. The circumflex artery (LCX) courses clockwise in the AV groove as it gives rise to one or more obtuse marginal branches.

The most frequent disease of the arteries is atherosclerosis which is characterized by lumen reduction of blood vessels due to local thickening of internal blood vessels caused by plaque/atheroma. As a cardiovascular disease, atherosclerosis is an interdisciplinary problem and one of the leading causes of death in developed countries. It begins in childhood, goes a long time without manifesting symptoms, increasing with age it begins to seriously threaten health. The most dangerous risk factors for the development of atherosclerotic disease are: Hyperlipidaemia, hypertension, smoking, diabetes, high fibrinogen, excessive weight and physical inactivity.

Objective: To determine stress level in medical ward patients of Hepatitis C visiting Lahore General Hospital, Lahore, Mayo Hospital Lahore and DHQ Layyah. To determine the role of increased stress level and BMI in developing systemic hypertension.

Design: Descriptive type of cross sectional. Place and duration of study: It took the 8 months starting from August 2, 2017 to April 7, 2018 in Lahore General Hospital, Mayo Hospital Lahore and DHQ Layyah. Subjects and methods: Purposive sample 124 ward patients with sociodemographic questionnaire, Perceived Stress Scale (PSS) and BP recording were filled by research participants.

Results: Our study showed a significant positive correlation between Perceived Stress Score, Body Mass Index (BMI) and Blood Pressure both SBP as well as DBP. There was a positive correlation in the formal education and developing the perceived stress and it could be designated to the higher work burden and lack of satisfaction with the job (p<0.05). Our study indicated statistically a very strong relationship between perceived stress and developing prehypertension and hypertension stage 1 (p<0.001).

Conclusion: The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were higher among males as compared with females. Prevalence of prehypertension among overweight/obese and tense subjects suggested an early diagnosis of prehypertension and intervention including life style modification, particularly weight management.

Introduction: The parameters of pulse wave analysis, an emerging modality, are strong predictors of cardiovascular events and all-cause mortality. Systemic arterial hypertension and type 2 diabetes mellitus promote arterial stiffness, thereby modifying the characteristics of the pulse wave. This study analyzed and compared the pulse wave parameters of patients with diabetes and/or hypertension, using the oscillometric method.

Methods: In this cross-sectional study, the 110 study subjects were divided into three groups: Hypertensive– diabetic, hypertensive, and diabetic. An oscillometric pulse wave test was performed using Mobil-O-Graph® PWA equipment. The following variables were assessed: Age, body mass index, augmentation index, pulse wave velocity, peripheral arterial pressure, and central arterial pressure.

Results: The mean age of the study population was 61.3 years (standard deviation: 1.2). The mean body mass index was 29.3 kg/m2 (standard deviation: 2.9). The hypertensive–diabetic group had the highest mean pulse wave velocity and peripheral and central arterial pressure values. Moreover, the systolic peripheral and central arterial pressures of the hypertensive–diabetic group were significantly higher than those of the other two groups (p<0.05). All analyzed parameters were strongly correlated between the diabetic group and the hypertensive group (p<0.0001).

Conclusion: Patients with overlapping cardiovascular risk factors of diabetes and hypertension had the highest PWV and peripheral and central arterial pressure values. Hypertension and diabetes, as isolated conditions, were equivalent in their alterations of pulse wave analysis parameters.

Background: The coronary artery disease (CAD) is an important risk which causes death and disability. ABO blood group is genetically transmitted through chromosome, which has some role not only in the cholesterol balance and lipid homeostasis but also inflammatory markers and thrombosis. It is supposed to have a role in developing CAD. But the relationship between CAD and ABO blood group is still controversial. Here we conducted a metaanalysis aim to evaluate the role of each blood group on CAD.

Method: We searched the related articles from PubMed and Embase which record the patients with CAD and themselves blood group. We compared the risk between each group with the others to evaluate the significance of each group to CAD.

Result: In our analysis, the O group is more frequent in coronary artery disease followed by A, B and AB group successively, which is partly different with previous meta-analysis. Compared with A blood group, O group is more subjected to CAD (OR=0.97, 95% CI=0.83 TO 1.14, p=0.73) and AB group seem to be a protective factor (OR=6.52, 95% CI=4.83 to 8.81, p<0.00001).

Conclusion: The statistical significance between A and O is unclear, but there are reasons to believe that blood group influences the incidence of CAD. O and A are served as risk factors of CAD, when AB group may be the protective factor. The subsequent mutual comparisons in B, AB and O have the similar results.