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Shortness of breath (SOB) is a common symptom referral for dobutamine stress echocardiography (DSE). Patients with SOB and a normal DSE have worse long-term outcome than the general population. This suggests multiple aetiologies are involved. The purpose of this study was to assess the prevalence and clinical significance of undiagnosed COPD amongst patients referred for a DSE with SOB.We prospectively studied 114 patients referred for DSE with SOB without prior evidence of lung disease (mean age 64.9 ± 18.5 years, 60 male). Respiratory function testing using spirometry was performed on all patients on the day of their DSE. The study end-points were cardiac events and total mortality.Respiratory function testing and DSE was performed in all patients and COPD was highly prevalent (n = 93). Multivariate Cox regression analysis was used to estimate the effect of dyspnoea on non-fatal cardiac events (NFCE) and all-cause mortality. Over a mean follow-up of 4.5 ± 2.6 years, the composite end-point of NFCE and all-cause mortality occurred in 62.7% and 16.7% patients, respectively. COPD (HR 1.27; 95% CI 1.17-1.93), previous myocardial infarction (HR 1.84; 95% CI 1.06-3.2), myocardial ischaemia (HR 2.56; 95% CI 1.48-4.43), peak wall motion score index (HR 4.66; 95% CI 2.26-9.6), and mitral E/E' (HR 1.21; 95% CI 1.1-1.33) were significantly associated with a NFCE. Myocardial ischaemia (HR 4.43; 95% CI 1.24-15.81) was the only independent predictor of all-cause mortality.Undiagnosed COPD is highly prevalent and independently associated with worse outcome amongst patients with SOB referred for DSE. Symptom presentation is therefore an important consideration when interpreting DSE results.

The primary purpose of this study was to examine lateral deviations in center of pressure as a result of an extreme-duration load carriage task, with particular focus on heel contact. A total of 20 (n = 17 males and n = 3 females) soldiers from a special operation forces unit (body mass 80.72 [21.49] kg, stature 178.25 [8.75] cm, age 26 [9] y) underwent gait plantar pressure assessment and vertical jump testing before and after a 43-km load carriage event (duration 817.02 [32.66] min) carrying a total external load of 29.80 (1.05) kg. Vertical jump height decreased by 18.62% (16.85%) from 0.30 (0.08) to 0.24 (0.07) m, P P = .035, Glass delta = 0.44 and 1.28 [0.40] vs 1.46 [0.41] body weight, P = .015, Glass delta = 0.45, respectively) and increases in lateral center of pressure displacement were observed as a result of the load carriage task 14.64 (3.62) to 16.97 (3.94) mm, P

BackgroundThe epidemic of COVID-19 has rapidly spread worldwide, with millions of confirmed cases and related deaths. Numerous efforts are being made to clarify how the infection progresses and potential factors associated with disease severity and mortality. We investigated the mortality in Greek hospitalized COVID-19 patients and also the predictors of this mortality.MethodsStudy population included 512 COVID-19 patients admitted to the hospitals of the Attica region of Greece. Patients’ demographic characteristics, comorbidities, allergies, previous vaccination for seasonal influenza virus, admission to ICU, intubation, and death were recorded. Potential predictors of in-hospital mortality were identified by regression analysis.ResultsThe mean age of hospitalized patients was 60.4 years, and was higher in patients who deceased. The most common comorbidities were respiratory diseases, hypertension, gastrointestinal disorders, dyslipidemia, mental health diseases, asthma, diabetes mellitus and cardiovascular diseases. The need for ICU care and intubation was significantly higher among patients who died. The mortality rate was 15.8% (81 out of 512). Age ≥65 years, cancer, chronic kidney disease, endocrine diseases, central nervous system disorders, anemia, and intubation were independently associated with increased in-hospital mortality, while allergies and previous influenza vaccination were associated with decreased in-hospital mortality.ConclusionOur finding of a beneficial effect of allergies and influenza vaccination against COVID-19 infection merits further investigation, as it may shed light in the mechanisms underlying disease progression and severity. Most importantly, it may assist in the implementation of efficient protective measures and public healthcare policies.

Background The incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK. Methods DSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2 %] Indian Asian, 2219 [41.6 %] European white and 434 [8.1 %] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality. Results There were 849 (15.9 %) NFCE and 1365 (25.6 %) deaths over a median follow-up period of 4.6 years. In total 1174 (22 %) patients had inducible myocardial ischaemia during DSE, 859 (16.1 %) had fixed wall motion abnormalities and 3645 (68.4 %) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups. Conclusions DSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected. Electronic supplementary material The online version of this article (doi:10.1186/s12947-015-0028-1) contains supplementary material, which is available to authorized users.

Background Chylous cardiac tamponade is a rare condition with little known cause. Case presentation A case of an otherwise healthy woman who admitted with dyspnea and palpitations is presented. She had a history of a painful flexion-hyperextension of the spine. Diagnostic evaluation proved a chylous pericardial effusion with a disruption of the anterior longitudinal spinal ligament. Video-assisted thoracic surgery with mass supradiaphragmatic ligation of the thoracic duct and pericardial window formation was carried out successfully and resulted in the complete cure of the patient's condition. Conclusion Chylous pericardial effusion and subsequent tamponade is a rare entity. Endoscopic surgery is offering a safe and effective treatment.