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Background Previous echocardiographic studies have revealed an association between enlarged cardiac chamber volumes and elevated troponin concentrations. An automatic 4-chamber volumetric analysis tool was adopted to investigate this association in patients who underwent cardiac-gated computed tomography angiography (CCTA). Hypothesis We hypothesized that troponin concentration within the normal range correlates with cardiac chambers' volumes. Methods Serum troponin was obtained from 157 ambulatory patients before undergoing CCTA for nonacute coronary artery evaluation. Volumes of the cardiac chambers and the left ventricular mass were automatically analyzed and indexed to body surface area. Patients with a troponin concentrations within the upper quartile (>0.007 ng/mL, n = 39) were compared to patients with a troponin concentrations within the 3 lower quartiles of troponin concentrations (≤0.007 ng/mL, n = 118). Results None of the patients had a troponin concentration >0.05 ng/mL (the 99th percentile of the general population). There were no significant differences in baseline characteristics between the groups. There were significant correlations between troponin and ventricular volumes after adjustments for age and gender. In an analysis that included 107 patients without any known heart diseases, including those pathological findings in the current CCTA, there were significant correlations between troponin and the left and right ventricular volumes after adjustments for age, gender, and baseline characteristics (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, P = 0.002 and OR: 1.11, 95% CI: 1.04-1.19, P = 0.002; respectively). Conclusions Using the technology of automatic volumetric analysis in individuals undergoing CCTA, an association between larger right and left cardiac chambers and higher levels of troponin concentration was shown.

Introduction Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. Hypothesis The Roth score has correlation with dyspnea severity. Methods This is a prospective, controlled-cohort study. Roth score index is measured by having the patient count from 1 to 30 in their native language, in a single breath, as rapidly as possible. The primary result of the Roth score is the duration of time and the highest number reached. Results There was a strongly positive correlation between pulse oximetry and both maximal count achieved in 1 breath (r = 0.67; P 8 seconds had a sensitivity of 78% and specificity of 73% for pulse oximetry

Summary Peripheral blood mononuclear cells (PBMC) of untreated, HIV-infected patients contain HIV-specific CD8 T cells as well as their corresponding targets, HIV-infected CD4 T cells. To determine if CD4 T-cell depletion in HIV-infected patients may result from autologous CD8–CD4 T-cell interaction, CD8 and CD4 T cells procured from PBMC of acute and chronic untreated HIV-infected patients were sorted and co-incubated. Formation of CD8-CD4 T-cell conjugates was observed by fluorescence microscopy. Apoptosis of CD4 T cells in conjugation was recorded by digitized images and was further observed and measured by FACS using Annexin staining. Perforin expression in the CD8 T cells was measured using intracellular monoclonal perforin antibody staining. HIV DNA in the conjugated CD4 T cells was detected by in situ PCR. We found that 6·1 ± 0·5% of CD4 T cells from acute HIV-infected patients and 3·0 ± 0·5% from chronic HIV-infected patients formed CD8–CD4 T-cell conjugates. Annexin binding and cell morphology typical of apoptosis were observed in the conjugated CD4 T cells. The majority of CD8 T cells that had conjugated to CD4 T cells expressed perforin. The conjugated CD4 T cells exhibited nuclear HIV DNA. CD8 T cells and HIV-infected CD4 T cells, both procured from the PBMC of untreated HIV-infected patients, form conjugates. Apoptotic lytic activity has been observed in the conjugated CD4 T cells. We propose that CD4 T-cell annihilation in HIV-infected patients results, at least in part, from the interactions of perforin-rich CD8 T cells with autologous, HIV-infected CD4 T cells.