Karishma Sidhu

Effects of High and Low Fat Dairy Food on Cardio-Metabolic Risk Factors: A Meta-Analysis of Randomized Studies

Importance Clear guidelines on the health effects of dairy food are important given the high prevalence of obesity, cardiovascular disease and diabetes, and increasing global consumption of dairy food. Objective To evaluate the effects of increased dairy food on cardio metabolic risk factors. Data Sources Searches were performed until April 2013 using MEDLINE, Science Direct, Google,Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings. Study Selection Randomized controlled studies with healthy adults randomized to increased dairy food for more than one month without additional interventions. Data Extraction and Synthesis A standard list was used to extract descriptive, methodological and key variables from all eligible studies. If data was not included in the published report corresponding authors were contacted. Results 20 studies with 1677 participants with a median duration of dietary change of 26 (IQR 10-39) weeks and mean increase in dairy food intake of 3.6 (SD 0.92) serves/day were included. There was an increase in weight with low (+0.82, 0.35 to 1.28 kg, p<0.001) and whole fat dairy food (+0.41, 0.04 to 0.79kg, p=0.03), but no significant change in waist circumference (-0.07 , -1.24 to 1.10 cm) ; HOMA –IR (-0.94 , -1.93 to 0.04 units); fasting glucose (+1.32 , 0.19 to 2.45 mg/dl) ; LDL-c (1.85 ,-2.89 to 6.60 mg/dl); HDL-c (-0.19 , -2.10 to 1.71 mg/dl); systolic BP (-0.4, -1.6 to 0.8 mmHg); diastolic BP (-0.4 , -1.7 to 0.8 mmHg) or CRP (-1.07 , -2.54 to 0.39 mg/L). Changes in other cardio-metabolic risk factors were similar for low and whole fat dairy interventions. Limitations Most clinical trials were small and of modest quality. . Conclusion Increasing whole fat and low fat dairy food consumption increases weight but has minor effects on other cardio-metabolic risk factors. Trial Registration ACTRN Australian New Zealand Clinical Trials Registry ACTRN12613000401752, http://www.anzctr.org.au Ethics Approval Number NTX/10/11/115

Evaluation of a novel sphygmomanometer, which estimates central aortic blood pressure from analysis of brachial artery suprasystolic pressure waves.

Background: Central arterial pressure is a better predictor of adverse cardiovascular outcomes than brachial blood pressure, but noninvasive measurement by applanation tonometry is technically demanding. Method: Pulsecor R6.5 is a novel device adapted from a standard sphygmomanometer which estimates the central aortic pressure from analysis of low-frequency suprasystolic waveforms at the occluded brachial artery. A physics-based model, which simulates the arterial system using elastic, thin-walled tube elements and Navier–Stokes equations, is used to calculate arterial pressure and flow propagation. To determine the reliability of the device, we compared 94 central systolic pressures estimated by Pulsecor to the simultaneous directly measured central aortic pressures at the time of coronary angiography in 37 individuals. Results: There was good correlation in central SBP between catheter measurements and Pulsecor estimates by either invasive or noninvasive calibration methods (ru200a=u200a0.99, Pu200a<u200a0.0001 and ru200a=u200a0.95, Pu200a<u200a0.0001, respectively). The mean difference in central systolic pressure was 2.78 (SD 3.90)u200ammHg and coefficient of variation was 0.03 when the invasive calibration method was used. When the noninvasive calibration method was used, the mean difference in central systolic pressure was 0.25 (SD 6.31)u200ammHg and coefficient of variation was 0.05. Conclusion: We concluded that Pulsecor R6.5 provides a simple and easy method to noninvasively estimate central SBP, which has highly acceptable accuracy.

Do echocardiographic parameters predict mortality in patients with end-stage renal disease?

Background Left ventricular function predicts cardiovascular mortality both in the general population and those with end-stage renal disease. Echocardiography is commonly undertaken as a screening test before kidney transplantation; however, there are little data on its predictive power. Methods This was a retrospective review of patients assessed for renal transplantation from 2000 to 2009. A survival analysis using demographic and echocardiographic variables was undertaken using the Cox proportional hazards regression model. Results Of 862 patients assessed for transplantation, 739 had an echocardiogram and 217 of 739 (29%) died during a mean follow-up of 4.2 years. In a multivariate survival analysis, increased age (P<0.0001), diabetes (P<0.0001), transplant listing status (P<0.0001), severely impaired left ventricular function (P<0.01), pulmonary hypertension and/or right ventricular dysfunction (P=0.01), and regional wall motion abnormalities (P<0.01) were associated with all-cause mortality. Combined in a score where one point was given for the presence of each of the parameters above, these factors were strongly predictive of increased mortality with a hazard ratio of 3.57, 6.80, and 44.47 for the presence of one, two, or more factors, respectively, compared with the absence of any of these factors. Conclusions In patients with end-stage renal disease, multiple easily determined echocardiographic parameters, including regional wall motion abnormalities and pulmonary hypertension and/or right ventricular dysfunction, were independently associated with all-cause and cardiovascular mortality. Combining these factors in a simple score may further assist in risk stratifying patients being considered for renal transplantation.

Reduced embolic load during clinical cardiopulmonary bypass using a 20 micron arterial filter.

Objective: To compare the efficiency of 20 and 40 µm arterial line filters during cardiopulmonary bypass for the removal of emboli from the extracorporeal circuit. Methods: Twenty-four adult patients undergoing surgery were perfused using a cardiopulmonary bypass circuit containing either a 20 µm or 40 µm arterial filter (n = 12 in both groups). The Emboli Detection and Classification system was used to count emboli upstream and downstream of the filter throughout cardiopulmonary bypass. The mean proportion of emboli removed by the filter was compared between the groups. Results: The 20 µm filter removed a significantly greater proportion of incoming emboli (0.621) than the 40 µm filter (0.334) (p=0.029). The superiority of the 20 µm filter persisted across all size groups of emboli larger than the pore size of the 40 µm filter. Conclusion: The 20 µm filter removed substantially more emboli than the 40 µm filter during cardiopulmonary bypass in this comparison.

Isolated tricuspid valve surgery at a single centre: the 47-year Auckland experience, 1965-2011.

OBJECTIVESnIsolated tricuspid valve surgery is not commonly performed with few studies and limited numbers published. We reviewed the characteristics and outcomes, including survival, reoperation rates and their predictors of different types of isolated tricuspid surgery.nnnMETHODSnPatients coded for isolated tricuspid valve surgery were identified from the Green Lane Hospital database. Relevant clinical characteristics were collected from both clinical and written clinical records. Mortality was checked against the national Births, Deaths and Marriages database from the Ministry of Health.nnnRESULTSnSeventy-two consecutive patients (48 ± 16 years; 71% women, body mass index 25 ± 6) underwent isolated tricuspid valve surgery from 1965 to 2011. Valve repair was performed in 53 and 47% had a valve replacement. The majority of these operations were performed in the last two decades. Early mortality within 30 days of operation was 7.9% for repair and 17.6% for replacement (P = 0.29). The 1-, 5-, 10- and 25-year survival rates were 83.8, 74.5, 63.6 and 32.8% for tricuspid repair and 81.8, 68.2, 61.4 and 15.2% for tricuspid replacement, respectively. Preoperative loop diuretic dose (P = 0.0120) and preoperative haemoglobin level (P = 0.0377) were independent predictors of survival for all isolated tricuspid surgery, while preoperative creatinine level (P = 0.04) independently predicted reoperation during the follow-up.nnnCONCLUSIONSnBoth isolated tricuspid replacement and repair were associated with significant but acceptable early and late mortality with no statistically significant difference in cumulative survival. Preoperative loop diuretic dose, haemoglobin and creatinine are individually associated with survival and/or reoperation after isolated tricuspid valve surgery.

Clinical evaluation of emboli removal by integrated versus non-integrated arterial filters in new generation oxygenators.

Objective: To compare the emboli filtration efficiency of five integrated or non-integrated oxygenator-filter combinations in cardiopulmonary bypass circuits. Methods: Fifty-one adult patients underwent surgery using a circuit with an integrated filtration oxygenator or non-integrated oxygenator with a separate 20 µm arterial line filter (Sorin Dideco Avant D903 + Pall AL20 (n=12), Sorin Inspire 6 M + Pall AL20 (n=10), Sorin Inspire 6M F (n=9), Terumo FX25 (n=10), Medtronic Fusion (n=10)). The Emboli Detection and Classification quantifier was used to count emboli upstream and downstream of the primary filter throughout cardiopulmonary bypass. The primary outcome measure was to compare the devices in respect of the median proportion of emboli removed. Results: One device (Sorin Inspire 6 M + Pall AL20) exhibited a significantly greater median percentage reduction (96.77%, IQR=95.48 – 98.45) in total emboli counts compared to all other devices tested (p=0.0062 – 0.0002). In comparisons between the other units, they all removed a greater percentage of emboli than one device (Medtronic Fusion), but there were no other significant differences. Conclusion: The new generation Sorin Inspire 6 M, with a stand-alone 20 µm arterial filter, appeared most efficient at removing incoming emboli from the circuit. No firm conclusions can be drawn about the relative efficacy of emboli removal by units categorised by class (integrated vs non-integrated); however, the stand-alone 20 µm arterial filter presently sets a contemporary standard against which other configurations of equipment can be judged.

Long-term outcomes of heart failure patients who received primary prevention implantable cardioverter-defibrillator: An observational study

Implantable cardioverter‐defibrillator (ICD) therapy is indicated for selected heart failure patients for the primary prevention of sudden cardiac death. Little is known about the outcomes in patients selected for primary prevention device therapy in the northern region of New Zealand.

Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure

Objective Women have been under-represented in randomised clinical trials for primary prevention implantable cardioverter defibrillators (ICDs), and there are concerns about the efficacy of devices between genders. Our study aimed to investigate gender differences in the use of primary prevention ICD in patients with heart failure from the northern region of New Zealand. Methods Patients with heart failure with systolic dysfunction who received primary prevention ICD/cardiac resynchronisation therapy-defibrillator (CRT-D) in the northern region of New Zealand from 1 January 2007 to 1 June 2015 were included. Complications, mortality and hospitalisation events were reviewed. Results Of the 385 patients with heart failure implanted with ICD/CRT-D, women comprised 15.1% (n=58), and no change in utilisation of these devices was observed over the study period among women. Women were more likely to have non-ischaemic cardiomyopathy and have higher perioperative complications (8.6% vs 2.5%, P=0.02), with non-significant higher trend towards increased lead displacement (5.2% vs 1.8%, P=0.12). Women appeared to have lower all-cause (10.3% vs 18.7%, P=0.12), cardiovascular (5.2% vs 11.9%, P=0.13) and heart failure (3.5% vs 7.9%, P=0.22) mortalities but was not statistically significant. There were no gender differences in all-cause (70.7% vs 67%, P=0.58) or heart failure (19% vs 25%, P=0.32) readmissions. Conclusion Perioperative complications were significantly more common in women referred for ICD/CRT-D. Although there has been a significant increase in ICD implantation rates, gender differences in the use of these devices still exist in New Zealand, in keeping with the demographics of ischaemic heart disease and systolic dysfunction between genders.

Normal echocardiographic mitral and aortic valve thickness in children

Objective We aimed to define the normal range of aortic and mitral valve thickness in healthy schoolchildren from a high prevalence rheumatic heart disease (RHD) region, using a standardised protocol for imaging and measurement. Methods Measurements were performed in 288 children without RHD. Anterior mitral valve leaflet (AMVL) thickness measurements were performed at the midpoint and tip of the leaflet in the parasternal long axis (PSLA) in diastole, when the AMVL was approximately parallel to the ventricular septum. Thickness of the aortic valve was measured from PSLA imaging in systole when the leaflets were at maximum excursion. The right coronary and non-coronary closure lines of the aortic valve were measured in diastole in parasternal short axis (PSSA) imaging. Results were compared with 51 children with RHD classified by World Heart Federation diagnostic criteria. Results In normal children, median AMVL tip thickness was 2.0u2005mm (IQR 1.7–2.4) and median AMVL midpoint thickness 2.0u2005mm (IQR 1.7–2.4). The median aortic valve thickness was 1.5u2005mm (IQR 1.3–1.6) in the PSLA view and 1.4u2005mm (IQR 1.2–1.6) in the PSSA view. The interclass correlation coefficient for the AMVL tip was 0.85 (0.71 to 0.92) and for the AMVL midpoint was 0.77 (0.54 to 0.87). Conclusions We have described a standardised method for mitral and aortic valve measurement in children which is objective and reproducible. Normal ranges of left heart valve thickness in a high prevalence RHD population are established. These results provide a reference range for school-age children in high prevalence RHD regions undergoing echocardiographic screening.

Communicating projected survival with treatments for chronic kidney disease: patient comprehension and perspectives on visual aids

BackgroundMortality in end stage renal disease (ESRD) is higher than many malignancies. There is no data about the optimal way to present information about projected survival to patients with ESRD. In other areas, graphs have been shown to be more easily understood than narrative. We examined patient comprehension and perspectives on graphs in communicating projected survival in chronic kidney disease (CKD).MethodsOne hundred seventy-seven patients with CKD were shown 4 different graphs presenting post transplantation survival data. Patients were asked to interpret a Kaplan Meier curve, pie chart, histogram and pictograph and answer a multi-choice question to determine understanding.ResultsWe measured interpretation, usefulness and preference for the graphs. Most patients correctly interpreted the graphs. There was asignificant difference in the percentage of correct answers when comparing different graph types (pxa0=xa00.0439). The pictograph was correctly interpreted by 81% of participants, the histogram by 79%, pie chart by 77% and Kaplan Meier by 69%. Correct interpretation of the histogram was associated with educational level (pxa0=xa00.008) and inversely associated with agexa0>xa065 (pxa0=xa00.008). Of those who interpreted all four graphs correctly, there was an association with employment (pxa0=xa00.001) and New Zealand European ethnicity (pxa0=xa00.002).87% of patients found the graphs useful. The pie chart was the most preferred graph (p 0.002).The readability of the graphs may have been improved with an alternative colour choice, especially in the setting of visual impairment.ConclusionVisual aids, can be beneficial adjuncts to discussing survival in CKD.