[Association between central obesity and risk for heart disease in adults in China: a prospective study]

Meta-Analysis of Dynamic Electrocardiography in the Diagnosis of Myocardial Ischemic Attack of Coronary Heart Disease

Background and Aims

Patients with coronary artery disease (CHD) are prone to early myocardial ischemia; early diagnosis of myocardial ischemia is of great significance in judging disease progression and guiding clinical intervention. However, reports on the accuracy of dynamic electrocardiogram (ECG) in the diagnosis of myocardial ischemia in patients with CHD are inconsistent. The purpose of the current meta-analysis was to analyze the efficacy of ECG in the diagnosis of myocardial ischemia attack in CHD.

Methods

Chinese database (Wanfang, VIP, and CNKI) and English database (PubMed, Web of Science, Embase, SinoMed, and Cochrane Library) were searched. A study on the collection of dynamic ECG in the diagnosis of myocardial ischemic attack of coronary heart disease to extract data and calculate sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (- LR), and diagnostic odds ratio (DOR). Draw summary receiver operating characteristic curves (SROC), and calculate area under curve (AUC). Stata 15 software was used for meta-analysis.

Results

Twenty-seven literatures were included in this study. Meta-analysis results showed that Sen = 0.78 (95% CI: 0.73~0.82), Spe = 0.76 (95% CI: 0.68~0.82), +LR = 2.79 (95% CI: 2.17~3.59), −LR = 0.33 (95% CI: 0.27~0.40), AUC = 0.84 (95% CI: 0.80~0.87), and DOR = 9.66 (95% CI: 6.13~15.21). Subgroup analysis showed that the sensitivity of 12-lead ECG was higher than that of 3-lead ECG. The sensitivity and specificity of ST segment and QTc interphase changes were higher than those of ST segment changes alone (P < 0.05).

Conclusion

Dynamic ECG has high application value in the diagnosis of myocardial ischemia attack of coronary heart disease. But it is difficult to achieve a satisfactory level of use alone. ST segment combined with QTc interval observation can improve the diagnostic accuracy. Synchronous observation of ST segment and QTc interval can improve the diagnostic efficiency.

The Phenomenon of "Obesity Paradox" in Neck of Femur Fractures

Objective

To determine the association of body mass index (BMI) with 30 days and 1-year mortality outcomes of orthopedic elderly patients after hip fracture surgery.

Methods

This is prospective study conducted at Department of Orthopaedics, at a tertiary care public sector hospital in Karachi between Jan-2016 to Jan-2018. In this short follow-up study, we included the data of 490 patients, who were operated for neck of femur fractures in a public sector tertiary care hospital between Jan-2016 to Jan-2018. Patients were divided into different categories on the basis of BMI; BMI <20 Kg.m^-2 underweight, 20-24.99 Kg.m^-2 normal weight, BMI 25-29.99 Kg.m^-2 overweight, ≥30 obese. Mortality at 30 days and 1-year mortality were primary study end-points.

Results

Rate of re-admission within 30 days, major adverse cardiovascular events (MACE) within 30 days and 30 days mortality was high in underweight and lowest in obese patients. Thirty-day mortality rate was 2.7% in underweight, 1.3% in normal weight, 0.64% in over-weight and 0.0% in obese patients but this was not significant statistically (p-value 0.29). One-year mortality rate was significantly high in under-weight patients, 34.2%, 25.9% in normal weight, 21.4% in overweight and only 14.5% in obese patients (p-value 0.009). Age ≥ 65 years (odds ratio 0.40 (0.26-0.63), and ASA III-IV (odds ratio; 0.27 (0.16-0.45) are also significant risk factors of 1-year mortality.

Conclusion

BMI classification can serve as an important indicator of adverse early outcomes after hip fracture surgery. Over-weight and obese patients have better survival outcomes and have lower 1-year mortality rate.