The decline in serum testosterone in ageing men may be mediated in part by obesity; however, it is uncertain which measure of adiposity is most closely associated with testosterone levels. We have examined the relatio...The decline in serum testosterone in ageing men may be mediated in part by obesity; however, it is uncertain which measure of adiposity is most closely associated with testosterone levels. We have examined the relationships of age, adiposity and testosterone levels in ageing men with symptoms consistent with hypoandrogenism but who were otherwise in good health. We conducted a cross-sectional study of non-smoking men aged ≥ 54 years recruited from the community and who were free of cancer or serious medical illness. Height （Ht）, weight and waist circumference （WC） were measured, and body mass index （BMI） and waist-to-height （WHt） ratio were calculated. Two morning blood samples were collected for measurement of total testosterone （TT）, sex hormone binding globulin （SHBG） and luteinizing hormone （LH）. Free testosterone （cFT） was calculated. Multivariate linear regression analysis was performed to assess their relationship with measures of adiposity. Two hundred and seven men aged 54-86 years were studied. On univariate analysis WHt ratio was more strongly correlated with TI＂ and cFT than either WC or BMI. Furthermore, in models of TT and cFT, the addition of Ht to WC resulted in an increase in the magnitude of the regression coefficients for both WC （inverse correlate） and Ht （positive correlate）, with the contributions of both WC and Ht both being significant （P〈0.05 for all）. In conclusion, WHt ratio is the best anthropometric predictor of both TT and cFT in this group of healthy but symptomatic ageing men.展开更多
Background Coronary computed tomography angiography(CCTA)is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment....Background Coronary computed tomography angiography(CCTA)is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment.We sought to assess the image quality,luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease(CAD)and stable chest pain.Methods Retrospective analysis of elderly patients(>75 years)who underwent 320-detector row CCTA between 2012–2017 at MonashHeart.The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification,image quality by a 5-point Likert score(1-poor,2-adequate,3-good,4-very good,5-excellent)and presence of artefact limiting interpretability.Results 1011 elderly patients(62%females,78.8±3.3 years)were studied.Cardiovascular risk factor prevalence included:hypertension(65%),hyperlipidaemia(48%),diabetes(19%)and smoking(21%).The CCTA was evaluable in 68%of patients which included 52%with non-obstructive CAD(<50%stenosis),48%with obstructive CAD(>50%)stenosis.Mean Likert score was 3.1±0.6 corresponding to good image quality.Of the 323(32%)of patients with a non-interpretable CCTA,80%were due to calcified plaque and 20%due to motion artefact.Male gender(P=0.009),age(P=0.02),excess motion(P<0.01)and diabetes mellitus(P=0.03)were associated with non-interpretable CCTA.Conclusion Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain,clinicians should still be cautious about referring elderly patients for CCTA.Patients who are male,diabetic and>78 years of age are significantly less likely to have interpretable scans.展开更多
Surgical aortic valve replacement （AVR） is associated with very high peri-operative risk in the nonagenarian populationflI Patients with severe aortic stenosis treated conservatively have high rates of mortality wit...Surgical aortic valve replacement （AVR） is associated with very high peri-operative risk in the nonagenarian populationflI Patients with severe aortic stenosis treated conservatively have high rates of mortality with poor quality of life and loss of independence. Transcatheter aortic valve replacement （TAVR） has been validated in the high risk elderly population as a viable alternative to surgery with comparable outcomes.展开更多
The commonest cause of acute myocardial infarction involves the rupture or erosion of vulnerable atherosclerotic plaques followed by aggregation of platelets and subsequent thrombus formation, leading to partial or co...The commonest cause of acute myocardial infarction involves the rupture or erosion of vulnerable atherosclerotic plaques followed by aggregation of platelets and subsequent thrombus formation, leading to partial or complete epicardial coronary arterial occlusion. Over the last 25 years, advancement in therapeutic options for acute myocardial infarction has resulted in substantial improvement in morbidity and mortality. As a result, the absolute risk reduction of in-hospital deaths for patients presenting with STEMI has been on the decline in the last decade. The focus of the treatment for acute myocardial infarction involves achieving epicardial and microvascular patency, prevention of recurrent ischaemic events while balancing the risk of bleeding. This involves antiplatelet and antithrombotic therapies or fibrinolytic agents when timely performance of primary percutaneous coronary intervention is not possible. We review the evolution of treatment strategies for STEMI that has contributed to the improvement in patient outcome.展开更多
文摘The decline in serum testosterone in ageing men may be mediated in part by obesity; however, it is uncertain which measure of adiposity is most closely associated with testosterone levels. We have examined the relationships of age, adiposity and testosterone levels in ageing men with symptoms consistent with hypoandrogenism but who were otherwise in good health. We conducted a cross-sectional study of non-smoking men aged ≥ 54 years recruited from the community and who were free of cancer or serious medical illness. Height （Ht）, weight and waist circumference （WC） were measured, and body mass index （BMI） and waist-to-height （WHt） ratio were calculated. Two morning blood samples were collected for measurement of total testosterone （TT）, sex hormone binding globulin （SHBG） and luteinizing hormone （LH）. Free testosterone （cFT） was calculated. Multivariate linear regression analysis was performed to assess their relationship with measures of adiposity. Two hundred and seven men aged 54-86 years were studied. On univariate analysis WHt ratio was more strongly correlated with TI＂ and cFT than either WC or BMI. Furthermore, in models of TT and cFT, the addition of Ht to WC resulted in an increase in the magnitude of the regression coefficients for both WC （inverse correlate） and Ht （positive correlate）, with the contributions of both WC and Ht both being significant （P〈0.05 for all）. In conclusion, WHt ratio is the best anthropometric predictor of both TT and cFT in this group of healthy but symptomatic ageing men.
文摘Background Coronary computed tomography angiography(CCTA)is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment.We sought to assess the image quality,luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease(CAD)and stable chest pain.Methods Retrospective analysis of elderly patients(>75 years)who underwent 320-detector row CCTA between 2012–2017 at MonashHeart.The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification,image quality by a 5-point Likert score(1-poor,2-adequate,3-good,4-very good,5-excellent)and presence of artefact limiting interpretability.Results 1011 elderly patients(62%females,78.8±3.3 years)were studied.Cardiovascular risk factor prevalence included:hypertension(65%),hyperlipidaemia(48%),diabetes(19%)and smoking(21%).The CCTA was evaluable in 68%of patients which included 52%with non-obstructive CAD(<50%stenosis),48%with obstructive CAD(>50%)stenosis.Mean Likert score was 3.1±0.6 corresponding to good image quality.Of the 323(32%)of patients with a non-interpretable CCTA,80%were due to calcified plaque and 20%due to motion artefact.Male gender(P=0.009),age(P=0.02),excess motion(P<0.01)and diabetes mellitus(P=0.03)were associated with non-interpretable CCTA.Conclusion Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain,clinicians should still be cautious about referring elderly patients for CCTA.Patients who are male,diabetic and>78 years of age are significantly less likely to have interpretable scans.
文摘Surgical aortic valve replacement （AVR） is associated with very high peri-operative risk in the nonagenarian populationflI Patients with severe aortic stenosis treated conservatively have high rates of mortality with poor quality of life and loss of independence. Transcatheter aortic valve replacement （TAVR） has been validated in the high risk elderly population as a viable alternative to surgery with comparable outcomes.
文摘The commonest cause of acute myocardial infarction involves the rupture or erosion of vulnerable atherosclerotic plaques followed by aggregation of platelets and subsequent thrombus formation, leading to partial or complete epicardial coronary arterial occlusion. Over the last 25 years, advancement in therapeutic options for acute myocardial infarction has resulted in substantial improvement in morbidity and mortality. As a result, the absolute risk reduction of in-hospital deaths for patients presenting with STEMI has been on the decline in the last decade. The focus of the treatment for acute myocardial infarction involves achieving epicardial and microvascular patency, prevention of recurrent ischaemic events while balancing the risk of bleeding. This involves antiplatelet and antithrombotic therapies or fibrinolytic agents when timely performance of primary percutaneous coronary intervention is not possible. We review the evolution of treatment strategies for STEMI that has contributed to the improvement in patient outcome.
