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PubMed2000

Tei-index in patients with mild-to-moderate congestive heart failure.

BACKGROUND: Congestive heart failure is related to contraction and relaxation abnormalities of the ventricle. Isolated analysis of either mechanism may not be reflective of overall cardiac dysfunction. A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time, 'Tei-Index') has been described which may be more effective for analysis of global cardiac dysfunction than systolic and diastolic measures alone. It was the aim of the present investigation to evaluate the Tei-Index against invasive examination. METHODS AND RESULTS: Eighty-one subjects were included in a consecutive manner, among 125 patients undergoing left heart catheterization for invasive measurement of left ventricular end-diastolic pressure; 43 patients had congestive heart failure (35 male, 8 female, 68+/-6 years) defined by NYHA functional class >/=2 (mean 2.5+/-0.5) and left ventricular end-diastolic pressure >/=16 mmHg (mean 20+/-4) and 38 subjects (32 male, 6 female, 66+/-5 years) without symptoms of heart failure (NYHA functional class I) and with normal left ventricular end-diastolic pressure (mean 12+/-3 mmHg) served as a control group. Using conventional echo-Doppler methods, parameters assessed were: ejection fraction, peak velocities of early (E) and late (A) diastolic filling, the E/A ratio, deceleration time, isovolumic contraction time, isovolumic relaxation time and ejection time. The Tei-Index was obtained by subtracting ejection time from the interval between cessation and onset of the mitral flow. The control group and patients with congestive heart failure did not differ with respect to the E/A ratio (0.86+/-0.27 vs 0.90+/-0.44, P=ns), deceleration time (203+/-42 ms vs 206+/-36 ms, P=ns) and isovolumic relaxation time (97+/-16 ms vs 94+/-26 ms, P=ns). The ejection fraction was slightly reduced in patients with congestive heart failure (46+/-11% vs 55+/-8%, P<0.05). The Tei-Index was easily and reproducibly measured in all subjects. The mean value of the Tei-Index was significantly different between the control group and patients with congestive heart failure (0.39+/-0.10 vs 0.60+/-0.18, P<0.001). Receiver operating characteristic curve analysis for the Tei-Index yielded an area under the curve of 0.88+/-0.038. Using a Tei-Index >/=0.47 as the cutpoint, congestive heart failure was identified with a sensitivity of 86% and a specificity of 82%. No correlation was observed between the Tei-Index and heart rate (r=0.22, P=ns), systolic blood pressure (r=0.16, P=ns) or diastolic blood pressure (r=0.08, P=ns). The Tei-Index was significantly related to left ventricular end-diastolic pressure (r=0.46, P<0.01). CONCLUSION: The Tei-Index is a sensitive indicator of overall cardiac dysfunction in patients with mild-to-moderate congestive heart failure. The Tei-Index is easily obtained and may be used in the work-up of patients with suspected cardiac dysfunction.

Aged↗
PubMed2003

The renal arterial resistance index and renal allograft survival.

BACKGROUND: Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal arterial resistance index of less than 80 was predictive of long-term allograft survival. METHODS: The renal segmental arterial resistance index (the percentage reduction of the end-diastolic flow as compared with the systolic flow) was measured by Doppler ultrasonography in 601 patients at least three months after transplantation between August 1997 and November 1998. All patients were followed for three or more years. The combined end point was a decrease of 50 percent or more in the creatinine clearance rate, allograft failure (indicated by the need for dialysis), or death. RESULTS: A total of 122 patients (20 percent) had a resistance index of 80 or higher. Eighty-four of these patients (69 percent) had a decrease of 50 percent or more in creatinine clearance, as compared with 56 of the 479 patients with a resistance index of less than 80 (12 percent); 57 patients with a higher resistance index (47 percent) required dialysis, as compared with 43 patients with a lower resistance index (9 percent); and 36 patients with a higher resistance index (30 percent) died, as compared with 33 patients with a lower resistance index (7 percent) (P<0.001 for all comparisons). A total of 107 patients with a higher resistance index (88 percent) reached the combined end point, as compared with 83 of those with a lower resistance index (17 percent, P<0.001). The multivariate relative risk of graft loss among patients with a higher resistance index was 9.1 (95 percent confidence interval, 6.6 to 12.7). Proteinuria (protein excretion, 1 g per day or more), symptomatic cytomegalovirus infection, and a creatinine clearance rate of less than 30 ml per minute per 1.73 m2 of body-surface area after transplantation also increased the risk. CONCLUSIONS: A renal arterial resistance index of 80 or higher measured at least three months after transplantation is associated with poor subsequent allograft performance and death.

Biopsy↗
PubMed2002

Severe aortic valve stenosis with preserved and reduced systolic left ventricular function: diagnostic usefulness of the Tei index.

BACKGROUND: In patients with severe aortic valve stenosis (AS), the onset of heart failure is associated with increased mortality and higher operative risk. Heart failure may result from either systolic, diastolic, or "overall" left ventricular dysfunction. The index "isovolumic contraction time and isovolumic relaxation time divided by ejection time" was shown to be a sensitive indicator of "overall" cardiac dysfunction in patients with dilated cardiomyopathy and cardiac amyloidosis. We sought to define the role of the Tei index in patients with severe AS and to validate this index against conventional measures of systolic and diastolic LV function. PATIENTS AND METHODS: Fifty-three participants underwent left heart catheterization for invasive measurement of LV end-diastolic pressure as a marker of diastolic function: 10 AS patients (valve orifice 0.6 +/- 0.2 qcm) with depressed systolic LV function (defined by LV ejection fraction < or = 45% [mean 32% +/- 8%], 7 male/3 female, 72 +/- 10 years old, DAS group), 22 AS patients (valve orifice 0.7 +/- 0.2 qcm) with preserved systolic LV function (ejection fraction > 45% [mean 55% +/- 6%], 13 male/9 female, 71 +/- 11 years old, PAS group) and 21 asymptomatic control participants (ejection fraction > 45% [mean 62% +/- 8%], 14 male/7 female, 66 +/- 8 years old, CON group). Within 24 hours from catheterization, conventional 2-dimensional and Doppler echocardiographic examination including measurement of the Tei index was performed. RESULTS: LV end-diastolic pressure was elevated in the DAS and in the PAS group in comparison with control participants (32 +/- 6 mm Hg and 22 +/- 7 mm Hg vs 11 +/- 4 mm Hg, respectively, P <.01 for both comparisons). DAS patients were in a higher New York Heart Association functional class than PAS patients (3.2 +/- 0.4 vs 2.2 +/- 0.4, P <.001) The Tei index was easily and reproducibly obtained in all study participants. In the DAS group, isovolumic contraction time was prolonged and ejection time was shortened in comparison with the CON group (102 +/- 20 ms vs 52 +/- 15 ms, P <.01; and 235 +/- 44 ms vs 316 +/- 45 ms, P <.01), resulting in a significantly increased Tei index (0.78 +/- 0.28 vs 0.40 +/- 0.11, P <.01). In the PAS group, isovolumic relaxation time was shortened (62 +/- 18 ms vs 81 +/- 26 ms for the CON group, P <.01) and ejection time was prolonged (335 +/- 34 ms vs 316 +/- 45 ms for the CON group, P <.05), resulting in a decreased Tei index (0.29 +/- 0.12 vs 0.40 +/- 0.11, P <.05). Receiver operating characteristic curve analysis for the Tei index yielded an area under the curve of 0.98 +/- 0.03 for separating DAS and PAS patients. Using a Tei index greater than 0.42 as a cutoff, DAS patients were identified with a sensitivity of 100% and a specificity of 91%. CONCLUSION: The Tei index is significantly increased in patients with severe AS and depressed overall cardiac LV function. In AS patients with predominant diastolic dysfunction, in whom systolic function is preserved, the index is decreased in comparison with control patients. The index differentiates between symptomatic AS patients with depressed and less symptomatic AS patients with preserved systolic LV function, and may thus provide relevant information in the work-up and care of such patients.

Aged↗
PubMed1990

The ponderal index in term newborn siblings.

Rohrer's ponderal index in newborns (birth weight/heights x 100) has been used as an indicator of fetal growth status, especially to assess asymmetrical intrauterine growth retardation. Because low birth weight and intrauterine growth retardation tend to recur in sibships, we examined patterns of sibling correlation in the ponderal index in 795 live term (greater than or equal to 37 weeks) singleton sibling pairs without birth defects born between 1966 and 1986 and fathered by male US Army veterans participating in a nationwide health study. Data on birth weight, length, gestational age, and other maternal and infant health characteristics were abstracted from hospital-of-birth medical records. The correlation coefficient of ponderal index in sib pairs was 0.24 (p less than 0.001). Compared with 627 infants who had a prior sib with a ponderal index between the 10th and 90th percentiles, 92 infants who had a prior sib with ponderal index less than the 10th percentile had a lower mean ponderal index and a higher proportion with ponderal index less than the 10th percentile (13.0% vs. 8.5%). On the other hand, 76 infants who had a prior sib with ponderal index greater than the 90th percentile had a higher mean ponderal index and higher proportion with ponderal index greater than the 90th percentile (17.1% vs. 10.2%). The clustering of ponderal index in siblings persisted after controlling for factors such as race, gender, maternal age, gravidity, year of birth, gestational age, pregnancy complications, and prior maternal illnesses. The findings point to the presence of genetic and/or maternal factors affecting the growth status of term newborn infants. The significance of the ponderal index needs to be examined in future genetic and epidemiologic studies of intrauterine growth.

Adult↗
PubMed2002

Augmentation index is associated with cardiovascular risk.

OBJECTIVES: Augmentation index is a parameter measured by pulse wave analysis (PWA) and is used as a surrogate measure of arterial stiffness. The aim of this study was to assess whether augmentation index is associated with cardiovascular risk, as well as to evaluate whether the determinants of augmentation index are different in patients with cardiovascular disease compared to healthy subjects. DESIGN AND METHODS: We related augmentation index to risk scores in 216 subjects with or without a cardiovascular disease. Subjects without cardiovascular disease were classified according to the 'coronary risk chart' of the European Society of Cardiology (ESC), and those with cardiovascular disease were classified using the SMART (Second Manifestations of ARTerial disease) score and the EPOZ (Epidemiological Prevention study Of Zoetermeer) function. Augmentation index was derived by PWA using carotid applanation tonometry. Augmentation index was also correlated to age, blood pressure, heart rate, smoking history, cholesterol, height, body mass index and gender in subjects categorized as healthy or with cardiovascular disease. RESULTS: Augmentation index significantly increased with increasing risk scores (P < 0.0001) and was significantly correlated to cardiovascular risk (ESC: P < 0.0001; SMART: P < 0.0001; EPOZ: P < 0.0001). In subjects with and without cardiovascular disease, augmentation index was correlated with diastolic blood pressure, heart rate, height and gender. Age was found to be significantly correlated with augmentation index only in healthy subjects but not in those with atherosclerotic disease. CONCLUSIONS: Our findings suggest that augmentation index may be a useful marker of cardiovascular risk. Further studies are required to investigate the relationship between age and augmentation index in subjects with atherosclerotic disease.

Adult↗
PubMed2002

Prothrombin index is an indirect marker of severe liver fibrosis.

OBJECTIVE: The non-invasive diagnosis of liver fibrosis is based mainly on biochemical markers. The main aim was to validate whether the prothrombin index is an indirect marker of the severity of liver fibrosis. PATIENTS AND METHODS: The predictive value of the prothrombin index for liver fibrosis was first assessed in 243 patients with chronic liver disease, then validated in 193 other patients with chronic liver disease. The reproducibility of measurement of the prothrombin index in different laboratories was evaluated in 82 other patients. RESULTS: In the first group, the prothrombin index was predicted accurately by serum hyaluronate (R(2)= 0.67 at the first step by multiple regression). The relationship between the prothrombin index and the area of fibrosis was not influenced significantly by non-fibrotic pathological lesions. The prothrombin index began to decrease when the Metavir fibrosis score was 2 versus 3 for albumin. In the second group, the prothrombin index and the histological fibrosis score were well correlated (r= -0.70, P< 10(-4)). Prothrombin index < or =80% or < or =70% diagnosed severe fibrosis or cirrhosis, respectively, and prothrombin index > or =105% or > or =100% excluded a diagnosis of severe fibrosis or cirrhosis, respectively, at the 95% probability level. The prothrombin indices measured in different laboratories were similar (78+/-18% v. 78+/-14%) and well correlated (r= 0.91, P< 10(-4)). CONCLUSIONS: The prothrombin index was well correlated with pathological liver fibrosis score, had a high diagnostic accuracy for severe fibrosis or cirrhosis especially due to alcohol, and was not influenced by other pathological lesions. The prothrombin index was reproducible. Thus, the prothrombin index expressed as a percentage is an accurate, reproducible, inexpensive and easily available marker of severe liver fibrosis.

Biomarkers↗
PubMed2006

Ambulatory arterial stiffness index: determinants and outcome.

OBJECTIVES: We hypothesized that one minus the slope of diastolic on systolic blood pressure in individual 24-h ambulatory blood pressure recordings (ambulatory arterial stiffness index) might reflect arterial stiffness and predict cardiovascular mortality. METHODS: In volunteers and a population recruited in China, we studied concordance between ambulatory arterial stiffness index and established indexes of arterial stiffness. We assessed the predictive value of ambulatory arterial stiffness index in relation to cardiovascular outcome in Irish hypertensive patients. RESULTS: In 166 healthy volunteers, aged 22-83 years, the correlation coefficient between ambulatory arterial stiffness index and pulse wave velocity was 0.51 (P<0.001). In 348 randomly recruited Chinese, the correlations between ambulatory arterial stiffness index and both the central and peripheral systolic augmentation indexes were significantly stronger than those for 24-h ambulatory pulse pressure, particularly in study participants younger than 40 years. Among normotensive participants, the 95th percentile of the ambulatory arterial stiffness index was 0.55 in 234 Chinese and 0.57 in 1617 Europeans enrolled in the International Database on Ambulatory Blood Pressure Monitoring. The upper boundary of the 95% prediction interval of the ambulatory arterial stiffness index in relation to age ranged from 0.53 at 20 years to 0.72 at 80 years. In 11 291 patients enrolled in the Dublin Outcome Study, both ambulatory arterial stiffness index and 24-h ambulatory pulse pressure significantly predicted cardiovascular mortality. Ambulatory arterial stiffness index was a strong predictor of fatal stroke in normotensive participants, whereas pulse pressure better predicted heart attack in hypertensive patients. CONCLUSION: Ambulatory arterial stiffness index is a novel measure of arterial stiffness, which can be readily determined from ambulatory blood pressure recordings and which independently predicts cardiovascular mortality.

Adult↗
PubMed2006

[Usefulness of a new index for mortality after hospitalization in adults older than 70 years].

BACKGROUND AND OBJECTIVE: Walter et al developed and validated a mortality prognostic index in older adults after hospitalization. Our objective was to evaluate the Walter index utility and to compare it with Charlson index and Barthel index in our population. PATIENTS AND METHOD: 455 patients were included (224 men and 231 women), medium age was 81.4 years (range: 70-99), who were discharged from 4 hospitals in Barcelona. At the moment of discharge Barthel index, Charlson index and Walter index were administered. RESULTS: One year after discharge the mortality was 40.66%. Medium Barthel index (standard deviation) was 64.42 (35.66), medium Charlson index was 3.07 (1.87), and medium Walter index was 5.34 (2.97). ROC curves analysis was done and it shows the bigger area under the curve was Walter index (0.691). CONCLUSIONS: It's proved the Walter index utility for mortality prognostic one year after discharge in elderly people who are admitted in our hospitals. This could be useful to make a care design and therapeutic objectives.

Aged↗
PubMed2005

Index variables for studying outcomes in vascular cognitive impairment.

Multivariable modeling in dementia risk factor studies is limited by the number of factors that can be analyzed practicably. Index variables, which integrate exposures, can efficiently reduce dimensionality. The Consortium to Investigate Vascular Impairment of Cognition study, a Canadian memory-clinic-based 30-month cohort study of 1,347 patients, used a vascular risk factor index (from 20 exposures) and a vascular clinical profile index (17 items). Patients with vascular cognitive impairment had higher index counts compared to those without cognitive impairment (0.16 +/- 0.11 vs. 0.07 +/- 0.07 for the risk factor index and 0.21 +/- 0.16 vs. 0.09 +/- 0.07 for the clinical profile index; p < 0.05). Both the death rate and the rate of cognitive impairment increased exponentially with the index variable (r > 0.90 for each index). The risk ratio for death was 1.12 (95% CI 1.09-1.15) for each increment of the risk factor index and was 1.23 (95% CI 1.1-1.28) for each increment of the clinical profile index. With each index, the areas under the receiver operating characteristic curves for predicting death and institutionalization ranged from 0.73 +/- 0.01 to 0.75 +/- 0.01. Construction of index variables that integrate multidimensional factors is a promising approach to assessing risk in multi-determined states.

Adult↗
PubMed2000

The reliability and validity of the self-reported patient-specific index for total hip arthroplasty.

BACKGROUND: The Patient-Specific Index is unique in that it reflects how individual patients weigh concerns in rating the outcome of total hip arthroplasty. The Patient-Specific Index was originally administered by an interviewer, which is not always feasible and can be costly. The purposes of the present study were (1) to create a self-reported version of the Patient-Specific Index, (2) to determine the reliability of this new self-reported version, and (3) to determine the relationship between the scores on the new self-reported version and those on the original interviewer-administered version. METHODS: A self-reported version of the Patient-Specific Index was developed, and a pilot test was performed on ten patients. Patients who were scheduled for a total hip arthroplasty or who had recently had a total hip arthroplasty were eligible for the reliability and validity testing. A copy of the new self-reported Patient-Specific Index was mailed to the patients, and they completed it independently. The patients' ratings of the importance and severity of twenty-four concerns prior to total hip arthroplasty were added together to create a summary Patient-Specific Index score. To determine test-retest reliability, patients completed the self-reported Patient-Specific Index a second time, two weeks later. To determine criterion validity, participants also completed the interviewer-administered Patient-Specific Index. RESULTS: Fifty-five patients completed the study. The random-effects intraclass correlation test-retest coefficient was 0.79 (greater than 0.75 represents excellent reliability). The mean Patient-Specific Index scores on the self-reported version and on the interviewer-administered version were 173 and 165 points, respectively (Student t test, p = 0.45). The self-reported Patient-Specific Index was concordant with the interviewer-administered Patient-Specific Index (intraclass correlation coefficient, 0.78). CONCLUSIONS: We concluded that a self-reported version of the Patient-Specific Index, which focuses on the concerns of individuals, is reliable and has criterion validity compared with an interviewer-administered version.

Activities of Daily Living↗
PubMedDate not supplied

Evaluation of the phosphorus index in watersheds at the regional scale.

Agricultural losses of phosphorus (P) in runoff are a primary cause of eutrophication in many freshwater systems. A modified version of the P Index originally developed jointly by the USDA (Agricultural Research Service [ARS], Cooperative State Research, Education, and Extension Service [CSREES], and Natural Resources Conservation Service [NRCS]) was used to prioritize P loss vulnerability at the regional scale from 60 watersheds located within Minnesota using readily available data related to the transport and sources of P. This modified version of the P Index was created for a regionally based analysis of the index. Validation of the P Index rating was conducted using long-term water quality monitoring data consisting of total P concentrations collected from watersheds and lakes. The modified version of the P Index produced a strong correlation between P Index rating and total P stream monitoring data in watersheds (r2 = 0.70) excluding the Red River Basin. An equally strong relationship was observed between P Index rating and lake water quality (r2 = 0.68) using the modified P Index. The P Index ratings for the Red River Basin showed good correlation with observed total P stream monitoring data (r2 = 0.51); however, the P Index ratings were smaller than in other basins. The results of this study suggest that, with certain limitations, the P Index can be used at the regional scale to prioritize P loss vulnerability using state and national databases. Regional P Index ratings represent the average risk for agricultural land within the entire watershed.

Agriculture↗
PubMed2005

An iterative procedure for deriving selection indexes with constant restrictions.

The objective of this study was to present an iterative procedure for deriving selection indexes with constant restrictions. Constant restriction means that the genetic responses of the restricted traits are preset to actual amounts for a given selection intensity (ī). Results of this study show that an index with constant restriction alone or in combination with other types of restrictions possesses three distinctive characteristics: 1) the coefficient matrix of the index equations is not symmetric and is nonlinear; 2) the coefficient matrix contains unknown ī, indicating that the index coefficients (b) to be derived depends on the value of ī predetermined before selection; and 3) the coefficient matrix contains unknown b, thus requiring iterative methods to solve the index equations. As a result of these unique characteristics, the index coefficients, genetic responses of the index traits, and overall genetic gain in net merit change nonlinearly with varying levels of ī, which is in sharp contrast to both unrestricted and restricted indexes reported in the literature. The construction of a constant-restricted index requires predetermining the value of ī intended for a selection program to derive the corresponding b. An index with constant restrictions has no meaning unless it is associated with a specific value of ī. Numerical examples are given to illustrate the construction of the index with constant restrictions and to validate the theoretical development proposed. The derived equations have yielded an index that maximized the total merit and fulfilled constant restriction at the same time.

Animals↗
PubMed1992

Influence of dietary fiber and buffer value index on the ruminal milieu of lactating dairy cows.

The influence of dietary buffer value index and dietary ADF content on ruminal fluid pH, buffering capacity, and buffer value index was measured. Four lactating Holstein cows (two primiparous) averaging 72 +/- 60 DIM were used in a 4 x 4 Latin square with 3-wk experimental periods. Treatments were a 2 x 2 factorial arrangement of TMR containing two ADF concentrations (16 and 21% of DM) and two buffer value indexes (calculated from analysis of individual dietary ingredients to be -200 and 0). Milk fat content and milk fat yield tended to be increased by high ADF, and protein yield tended to increase with low buffer value index and low ADF. Although the high ADF diets increased ruminal fluid pH, they reduced buffering capacity; because the magnitude of the pH increase was greater than the reduction in buffering capacity, ruminal fluid buffer value index was increased by added ADF. The high buffer value index diets reduced ruminal fluid pH and increased ruminal fluid buffering capacity; effects on pH outweighed those on buffering capacity so that the ruminal fluid index paradoxically decreased as the dietary index increased. Ruminal fluid acetate increased and propionate decreased as ADF increased. We conclude that ruminal fluid buffer value index increases with dietary ADF, likely because of reduced ruminal concentrations of fermentation acids. Because diets with the highest index produced the lowest ruminal indexes, dietary buffer value index must be studied further before it can be included in any model purporting to predict the need for supplemental dietary buffers.

Acetates↗
PubMed2001

[Indexes of auditory steady state response initiated by propofol of different concentrations].

OBJECTIVE: To assess the usefulness of auditory steady state response index (ASSR index) in monitoring the depth of sedation with propofol. METHODS: Propofol at the target plasma concentrations of 0.5, 1.0, 1.5 and 2.0 micrograms/ml respectively was administered to 30 ASA grade I-II adult patients to be operated on by computer controlled infusion technique. Two minutes after equilibration of the effect compartment's concentration electively the plasma propofol concentration, the 40 Hz ASSR was recorded immediately at every concentration. Then the infusion was discontinued. When the patients opened their eyes to verbal commands of normal intonation, the 40 Hz ASSR was recorded again. The ASSR index was calculated as the sum of the square root of the absolute difference between every two successive 0.5 ms segments of the auditory steady state response's waveform. The level of sedation was determined by the observer's assessment based on the alertness/sedation scale (OAA/S). The OAA/S score of 2 or less was considered unconscious. RESULT: The amplitudes of Pa and Pb waves and the ASSR index were linearly decreasing with the increase of propofol target concentration and the deepening of level of sedation dose-dependently with the association coefficients as r = 0.780, r = 0.826, and r = 0.759 respectively, P < 0.01. The corresponding regression equations are as follows: Pa = -0.354 x target concentration +1.018, and Pb = -0.468 x target concentration +1.247, ASSR index = -2.924 x target concentration +11.78. The ASSR index reflected the amplitudes of Pa and Pb, especially the amplitude of Pa (r = 0.811 and 0.735 respectively, P < 0.01). In addition, ASSR index was correlated with the depth of patient's sedation (r = 0.815, P < 0.01). When the patients fell asleep from drowsy state, the amplitude of Pa decreased from 0.9 mu v to 0.6 mu v, and the ASSR index decreased from 10.5 to 8.6 with statistical significance (P < 0.05). The patients would not fall asleep until the ASSR index reduced to about 8.5, while reliable unconsciousness happened only when the ASSR index was lower than 5.6. CONCLUSION: ASSR index is useful in monitoring the depth of sedation with propofol. Compared with the amplitudes of Pa and Pb observed traditionally, ASSR index is more accurate and simple and convenient.

Adult↗
PubMed2004

Low glycaemic index diets for coronary heart disease.

BACKGROUND: The glycaemic index (GI) is a physiological measure of the ability of a carbohydrate to affect blood glucose. Interest is growing in the low GI carbohydrate concept for the clinical management of people at risk of, or with established coronary heart disease. There is a need to review the current evidence from controlled trials in this area. OBJECTIVES: The primary objective is to review the current evidence from RCTs that assess the relationship between the consumption of low glycaemic index diets and the effects on coronary heart disease and on risk factors for coronary heart disease. SEARCH STRATEGY: We searched CENTRAL (Issue 4, 2003), MEDLINE (1966 to 2003), EMBASE (1980 to 2003) and CINAHL (1982 to 2003). We also contacted experts in the field. SELECTION CRITERIA: We selected randomised controlled trials that assessed the effects of low glycaemic index diets, over a minimum of 4 weeks, on coronary heart disease (CHD) and risk factors. Participants included were adults who carry at least one major risk factor for coronary heart disease such as abnormal lipids, diabetes or being overweight. DATA COLLECTION AND ANALYSIS: Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information when this was appropriate. MAIN RESULTS: Fifteen randomised controlled trials met the inclusion criteria. No studies found reported the effect of low glycaemic index diets on CHD mortality or CHD events and morbidity. All fifteen included studies report the effect of low glycaemic index diets on major risk factors for CHD. Meta-analysis detected limited and weak evidence of a relationship between low glycaemic index diets and slightly lower total cholesterol, compared with higher glycaemic index diets. There is also limited and weak evidence of a small reduction in HbA1c after 12 weeks on low glycaemic index diets but not at 4 to 5 weeks. There is no evidence that low glycaemic index diets have an effect on LDL cholesterol or HDL cholesterol, triglycerides, fasting glucose or fasting insulin levels. REVIEWERS' CONCLUSIONS: The evidence from randomised controlled trials showing that low glycaemic index diets reduces coronary heart disease and CHD risk factors is weak. Many of the trials identified were short-term, of poor quality and conducted on small sample sizes. There is a need for well designed, adequately powered, randomised controlled studies, of greater than 12 weeks duration to assess the effects of low glycaemic index diets for CHD.

Blood Glucose↗
PubMed1992

Mitotic indexes as prognostic predictors in female breast cancer.

A series of 688 women with breast cancer were followed-up for a mean of 13 years. Tumour size, axillary lymph node status, histological grade, histological type and two mitotic indexes (M/V; MAI) were assessed and related to disease outcome. Primary tumour size (P less than 0.0001), the volume-corrected mitotic index (M/V) (P less than 0.0001), the mitotic activity index (MAI) (P = 0.0001), and histological grade (P = 0.0074) predicted axillary lymph node status. Recurrence as well as recurrence-free survival was significantly related to the axillary lymph node status (P less than 0.0001), M/V index (P less than 0.0001), MAI (P less than 0.0001), tumour size (P = 0.0031) and histological grade (P = 0.0208). Multivariate analyses disclosed the tumour size and M/V index as independent predictors of axillary metastasis at diagnosis. Recurrence was related independently to M/V index, axillary metastasis and tumour size. Independent predictors of recurrence-free survival in Cox's analysis were M/V index and axillary lymph node status. Axillary lymph node status (P less than 0.0001), tumour size (P less than 0.0001), M/V index (P less than 0.0001), MAI (P less than 0.0001) and histological grade (P = 0.0009) predicted survival in that order. Cox's analysis showed that axillary lymph node status was the most important independent predictor of survival followed by tumour size and M/V index. In a separate Cox's analysis of axillary-lymph-node-negative patients the M/V index and tumour size were independently related to survival. In conclusion the M/V index is an important prognostic factor in breast cancer and also in axillary-lymph-node-negative breast tumours.

Breast Neoplasms↗
PubMedDate not supplied

Attenuation correction reveals gender-related differences in the normal values of transient ischemic dilation index in rest-exercise stress sestamibi myocardial perfusion imaging.

BACKGROUND: Transient ischemic dilation (TID) has been established as an important independent marker of severe and extensive coronary artery disease (CAD) in myocardial perfusion imaging (MPI). The accuracy of the TID index is dependent on a well-determined threshold (normal limits) between normal and abnormal values for each study protocol. To date, the effects of neither gender nor attenuation correction (AC) on TID normal limits have been established. Thus, the objectives of this study were to determine if AC processing changes the normal value of the TID index and if there were gender-related differences in the TID index of normal patients who had undergone rest/exercise-stress technetium-99m sestamibi MPI. METHODS AND RESULTS: Seventy-five patients (33 women, 42 men; mean age, 57.7 +/- 11.7 y and 55.9 +/- 10.0 y, respectively) with less than a 5% likelihood of CAD, who had undergone low-dose rest/high-dose exercise-stress Tc-99m sestamibi MPI, were studied. All studies were acquired using simultaneous emission/transmission scans and were corrected for attenuation, scatter, and resolution effects using the ExSPECT II method. Both the AC and non-AC studies were analyzed using the Emory Cardiac Toolbox (ECTb; Syntermed, Inc, Atlanta, Ga) quantitative software. The TID index was calculated automatically as the ratio of stress mean left ventricular volumes to rest mean left ventricular volumes by ECTb. Patients were grouped by gender and the TID indices from AC and non-AC studies were compared. Linear regressions of the TID index and body mass index were analyzed to exclude differences in body size between male and female patients as a confounding factor in gender-related differences in TID. The TID index upper normal limits were calculated as the mean value plus 2 standard deviations (SDs). AC processing did not change the TID index significantly whether the genders were combined or separated (AC TID = 0.97 +/- 0.14 vs non-AC TID = 0.98 +/- 0.12 for all patients). Female patients showed higher mean TID indices than male patients in both AC (1.01 +/- 0.15 vs 0.95 +/- 0.12) and non-AC studies (1.00 +/- 0.15 vs. 0.97 +/- 0.10), but this difference was statistically significant only in AC studies (p = .03). TID indices remained constant across the range of body mass index studied. The TID index upper normal limit was 1.31 for female and 1.18 for male patients. CONCLUSION: TID normal values for rest/exercise-stress Tc-99m sestamibi MPI are gender-dependent and not affected by AC processing. Thus, diagnosticians should take into account these gender-related differences, as compared with the traditional value generated from mostly male populations, to ensure both men and women have the same overall accuracy of using the TID index in the diagnosis and prognosis of CAD.

Adult↗
PubMed2005

Polysomnographic predictors of blood pressure and hypertension: is one index best?

STUDY OBJECTIVES: Numerous indexes derived from polysomnography are available to characterize sleep-disordered breathing, with no consensus over which measures best predict clinical outcomes. This study addresses the relative merits of using alternative polysomnography indexes by characterizing the consistency and strength of the association of each index with blood pressure and hypertension. DESIGN: Cross-sectional analyses of the association of alternative polysomnography indexes with blood pressure and hypertension were performed in construction and validation data sets. Linear and logistic regression models were used to identify the best variable sets. PATIENTS: Data were obtained from 6433 men and women (age 62.9 +/- 11.0 years, 52.8% women) who participated in the Sleep Heart Health Study. RESULTS: In multivariable models, most indexes showed weak linear associations with systolic, with slightly stronger associations for diastolic blood pressure, and the log odds of hypertension. No single index showed consistent superiority over others. Systolic blood pressure, diastolic blood pressure, and hypertension each were associated with distinct sets of polysomnography variables. Slightly more-consistent associations were demonstrated for indexes that included hypopneas that were linked with either a 3% or 4% desaturation level than indexes that did not require hypopneas to have linked desaturation. For indexes that combined apneas and hypopneas, there was no evidence that linking obstructive apneas to desaturation or arousal altered prediction compared with counting all apneas. CONCLUSION: In summary, using a rigorous cross-validation assessment, we did not identify a clear superiority of any single index for blood pressure or hypertension prediction. Detailed analyses of alternative definitions of the respiratory disturbance index support current scoring guidelines, where desaturation criteria are recommended for hypopneas but not apneas.

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