Use of Coronary Artery Calcium Quantification and Distribution for Coronary Vascular Disease Risk Reclassification in a Primary Prevention Setting.

In a large screening program of asymptomatic middle-aged individuals, we sought to assess the degree of risk reclassification provided by comparing multiethnic study on subclinical atherosclerosis coronary artery calcium scoring (CACS) versus atherosclerotic cardiovascular disease (ASCVD) and Reynolds risk score (RRS) score. All 5,324 consecutive patients (aged 57 ± 8 years, 76% male) who underwent CACS screening at the Cleveland Clinic as part of a primary prevention executive health between March 16 and October 21 were included. The 10-year ASCVD, RRS, and multiethnic study on subclinical atherosclerosis CACS (MESA-CACS) risk scores were calculated and categorized as <1, 1 to 4.

Reclassification of coronary heart disease risk in a primary prevention setting: traditional risk factor assessment . coronary artery calcium scoring.

Background: In a primary prevention screening program of asymptomatic middle-aged subjects, we sought to assess the degree of risk-reclassification provided by traditional risk assessment coronary artery calcification scoring (CACS).

Methods: A total of 1,806 consecutive asymptomatic subjects (age 55 years, 76% men), who underwent comprehensive screening in a primary prevention clinic between 3/2016 and 9/2017 were included. Standard risk factors, C-reactive protein (CRP) and CAC scoring were performed.

Incremental Prognostic Value of Exercise Stress Testing in Primary Prevention.

In primary prevention, addition of C-reactive protein and family history to standard risk factor assessment (Reynolds Risk Score or RRS) provides superior risk stratification for future cardiovascular (CV) events. We sought to assess whether addition of functional capacity to RRS provided incremental prognostic value. This was a prospective observational cohort study of 3,964 consecutive asymptomatic adults without documented CV disease (mean age 51 years, 78% men) evaluated between 2005 and 2013, who underwent clinical and treadmill stress testing at baseline.

Non-Mydriatic Ultra-Widefield Imaging Compared With Single-Field Imaging in the Evaluation of Peripheral Retinal Pathology.

Background And Objective: To report clinical feasibility of non-mydriatic ultra-widefield (NMUWF) imaging and determine the prevalence of peripheral retinal pathology in comparison to standard single-field imaging in a primary care setting.

Patients And Methods: Six hundred and thirty-two subjects (1,260 eyes) who underwent NMUWF imaging during annual health screening from October 2015 through March 2016 were retrospectively identified. An automated algorithm processed the raw images into: (1) NMUWF image with mask/grid outline that delineates the center 45° field simulating standard single-field photograph and (2) single-field image comprising 45° posterior pole extracted from the corresponding NMUWF image.

Non-mydriatic single-field fundus photography for the screening of retinal diseases in an executive health clinic.

Background And Objective: To determine the accuracy and sensitivity of a single-field non-mydriatic digital fundus image interpreted by an ophthalmologist and performed within a primary care setting.

Patients And Methods: Fundus photography using a digital non-mydriatic camera was performed on both eyes of 1,175 consecutive patients as part of an executive health program. All fundus images included a 45° field of the posterior pole capturing the optic nerve and macular area.

Taking blood pressure: too important to trust to humans?

The measurement of blood pressure in the physician's office is subject to a number of observer errors and also to the "white-coat effect." Automatic devices that measure blood pressure without a human observer in the room can eliminate many of these problems. We argue for greater use of these devices in the physician's office.

Total-body screening: preliminary results of a pilot randomized controlled trial.

Purpose: The authors performed a pilot randomized controlled trial of total-body screening to assess the feasibility of a full-scale study.

Materials And Methods: After informed consent, 50 asymptomatic people were randomized to either the intervention arm (total-body screening with multidetector computed tomography) or the control arm (no screening for 3 years). The study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act.

Strengthening the standards for preventing heart disease and stroke: the recent AHA guidelines.

Recent American Heart Association guidelines to prevent cardiovascular disease and stroke call for managing risk factors more aggressively than ever before, especially in people identified as being at high risk.

Clear cell adenocarcinoma arising from a urethral diverticulum.

Carcinoma of the urethra is rare with only about 1,500 cases in the literature. Even more rare is carcinoma arising from a urethral diverticulum with about 100 cases reported to date. We report a case of clear cell adenocarcinoma arising from a urethral diverticulum.

Pulmonary blastoma in children: report of two cases and review of the literature.

Pulmonary blastoma is a rare primary neoplasm of the lung. Approximately 25% of the reported cases have occurred in pediatric patients. The authors found 45 cases of these tumors in children aged < or = 16 years, and report two more cases of pulmonary blastoma--in a 3 1/2-year-old boy and a 22-month-old girl.

Serum potassium concentrations in trauma patients.

Hypokalemia occurs in 50% to 68% of trauma patients. To investigate the pathophysiology of these changes in serum potassium, we prospectively studied 133 trauma patients. Among the patients who had hypokalemia, the serum potassium usually decreased within 1 hour of trauma and returned to normal within 24 hours without significant potassium replacement.

Sarcoid cardiomyopathy precipitated by pregnancy with cocaine complications.

We report the case of a 27-year-old previously healthy multiparous black woman who developed congestive heart failure 5 days postpartum. It was initially diagnosed and treated as idiopathic peripartum cardiomyopathy. Five weeks later, pulmonary sarcoidosis was diagnosed by transbronchial biopsy specimen, and steroid therapy was begun.