Many people who experience chest pain, but don’t have a heart attack, breathe a big sigh of relief when a stress test comes back negative for blockages in their blood vessels. But a new study by cardiac researchers at the Intermountain Medical Center Heart Institute in Salt Lake City found they may not be off the hook after all.

Researchers studied 658 men and women between the ages of 57 and 77 who passed a stress test for blocked arteries and who were later found to have calcium in their arteries after being screened by imaging technology that measured their total coronary artery calcification.

They found that five percent of patients who passed their stress test and later tested high for calcium in their arteries – 31 of 658 patients – went on to have an adverse cardiac event within one year. Such events included death, heart attack and stroke.

Researchers say there is something more doctors can do to assess a patient’s risk of future heart attack: check the calcium – a sign of plaque build-up – in a patient’s arteries.

‘We now have the ability to better measure coronary artery calcification,’ says Viet Le, MPAS, PA-C, lead author of the Intermountain Medical Center Heart Institute study.

‘People say, I’m good. They gave me a stress test,” said Le. ‘But it doesn’t tell the whole story. The story it tells is that on that day your engine – your heart – passed the test. Some of these people die within a year from a heart attack.’

Cardiac experts have known for years that calcium left by plaque is a good marker of heart disease, but there was not good imaging technology to measure it without exposing the patient to too much radiation, Le said. That changed about five years ago.

PET/CT, an advanced nuclear imaging technology that combines positron emission tomography (PET) and computed tomography (CT) in one machine, allows physicians doing a chemical stress test to also measure coronary artery calcification.

Calcification cannot be reversed, but the plaque that causes it can be reduced or stabilized with proper medication, diet and exercise.

Researchers found that 33 patients in the study, or five percent, had no or mild calcification, and they had no cardiac events. But there was a significant correlation between the amount of calcium and the occurrence of cardiac events in the remainder of the patients.

Twelve of 309 (3.88 percent) patients with moderate calcification had a cardiac event within a year, 10 of 190 (5.26 percent) with severe calcification had a cardiac event within a year, and nine of 126 (7.14 percent) with very severe calcification had a cardiac event within a year. In total, 16.28 percent of calcified patients in the study had a heart event.

The results confirmed for Le the value of assessing calcification in patients suspected of having clogged arteries.

‘Right now, it’s a neglected tool that should better be utilized,’ he said.

Intermountain Healthcare intermountainhealthcare.org/news/2016/11/cardiac-pet-ct-imaging-effective-calcium-blockage-assessing-heart-attack-risk/

Researchers from UT Southwestern’s Peter O’Donnell Jr. Brain Institute and Harold C. Simmons Comprehensive Cancer Center collaborated with investigators in the Advanced Imaging Research Center to identify 2HG (2-hydroxyglutarate), a metabolite that is produced in gliomas that carry IDH (isocitrate dehydrogenase) gene mutations.

Using MR spectroscopy, the team announced in 2012 that they could detect 2HG in the tumour with high sensitivity and specificity. This next-step study showed that 2HG can be useful in tracking the disease, researchers said.

‘This is the first non-invasive biomarker for brain cancer and represents a major advance for the field. Our current imaging is not nearly as precise and takes a longer time to see results,’ said senior author Dr. Maher, who holds the Theodore H. Strauss Professorship in Neuro-Oncology. ‘Within a week of starting treatment, we know whether we hit the target’. This new method will be a much more rapid way of assessing the therapy – allowing the physician to know to stop treatments that aren’t working or continue treatments that are.’

Most biomarkers are in the blood, so identifying biomarkers that can be tracked without drawing blood or obtaining a tissue biopsy is particularly valuable, said Dr. A. Dean Sherry, Director of the Advanced Imaging Research Center and Professor of Radiology at UT Southwestern, and Professor of Chemistry at UT Dallas, where he holds the Cecil H. and Ida Green Distinguished Chair in Systems Biology.

The technique also may serve as a model to develop other imaging biomarkers for the brain, and already is being used to learn more about the biology of glioma, the most common type of brain cancer.

‘In terms of research, the biomarker is a window’ into IDH-mutant glioma biology and we are using it to learn more about how the tumour grows, responds to therapy, and ultimately becomes resistant to treatment,’ said lead author Dr. Changho Choi, Professor of Radiology and with the Advanced Imaging Research Center, where the study was performed using a dedicated research MR scanner.

2HG tracking also could prove useful in diagnosing some brain tumours in which typical surgical procedures to obtain tissue samples can’t be done. That may be because the tumour isn’t accessible, such as near the brainstem, or when trying to get a sample could cause neurological damage. These patients are excluded from clinical trials because of the lack of available tumour tissue for diagnostic analyses.

‘We established in this study that 2HG levels in these tumours can be used to make a presumptive’ molecular diagnosis of an IDH mutation, based solely on imaging,’ said Dr. Choi.

UT Southwestern Medical Center www.utsouthwestern.edu/newsroom/news-releases/year-2016/oct/biomarker-tracks-tumour.html

Researchers investigating a novel device to repair the mitral heart valve report 100 percent procedural success in a safety and performance study, the first such study done in humans. The image-guided device, based on technology developed at the University of Maryland School of Medicine, is deployed through a tiny opening in a beating heart, avoids open-heart surgery, automates a key part of the valve repair process, simplifies the procedure and reduces operating room time.
Traditional mitral valve repair is performed during open heart surgery, a lengthy operation in which the patient’s chest is opened, the heart is stopped and circulation is maintained with a heart-lung bypass machine. Recovery can take months, and patients face significant risks. As a result, there is considerable interest in finding less invasive mitral valve treatment options.
‘We think this is a safer approach than open heart surgery,’ says principal investigator James S. Gammie, MD, professor and chief of cardiac surgery at the University of Maryland School of Medicine. ‘We think the safety profile is going to be better and, ultimately, people will be able to go home from the hospital the next day.’
The device, known as the Harpoon TSD-5, made by Harpoon Medical Inc. of Baltimore, is an investigational device. At the present time, the US Food and Drug Administration has not approved the device for use in patients in the United States. It is designed to treat degenerative mitral regurgitation (MR), the most common type of heart valve disorder. In MR, a leaky valve lets blood travel in the wrong direction on the left side of the heart, causing shortness of breath, fluid retention, irregular heartbeats and fatigue. MR develops when the small fibrous cords that open and close the valve’s flaps, known as leaflets, are broken or stretched, preventing them from closing tightly and causing the leaflets to bulge or prolapse upward toward the left atrium. The natural cords connect the valve flaps to muscles inside the heart that contract to close the mitral valve, which gets its name because its two flaps resemble a bishop’s mitre.
The TSD-5 anchors artificial cords on the flaps to take the place of the natural cords. The artificial cords are made of expanded polytetrafluoroethylene (ePTFE), a polymer commonly used as sutures in cardiac surgery.
Surgeons insert the device into the beating heart through a tiny opening in the ribcage and, using echocardiographic imaging, guide it to the surface of the defective mitral flaps. When the surgeon determines the optimal placement for an artificial cord, the device is actuated and a specially designed needle wrapped with 50 coils of ePTFE makes a tiny hole and sends the cord material through the flap. An automated process makes a knot to hold the cord in place. The other end of the cord is adjusted for optimum length and tied to the outside layer of the heart, the epicardium. Three or four cords are required for most cases.
Gammie says the ability to make adjustments to the artificial cords while the heart is beating is a key advantage over open heart surgery: ‘The heart’s fully loaded and beating and we can just adjust the length of the cords to optimize the result, and only when we’re really happy do we tie it off.’

University of Maryland School of Medicine http://tinyurl.com/j5m9lmp

‘Addressing the challenge of patient-centred care and safety’ was the theme addressed in the International Hospital Federation (IHF) 40th World Hospital Congress held in Durban, South Africa, 31 October to 3 November 2016, attended by national and international healthcare leaders and organizations from 50 countries.

Discussions on the challenges being encountered by different countries when it comes to making patients the centre of quality and affordable healthcare services and management, as well as the solutions on how to improve hospitals’ delivery of quality care and the healthcare status of each country were tackled.
Quality of Care, Capacity Building in Leadership and Management, Governance and Accountability, Ethics and Medical Legal Issues, Financing and Universal Health Coverage, Health Technology, and Service Delivery were some of the tracks explored during the Congress.
Dr. Aaron Motsoaledi, the Honourable Minister of Health of the host country, Republic of South Africa, mentioned in his welcome message the two objectives of the South African National Development Plan that are needed to be comprehended not only by African healthcare leaders and personnel, but by all healthcare leaders internationally: ‘(1) The quality of services in the public health system must be improved (2) The relative cost of private healthcare must be reduced.’
These two important points were emphasized and tackled in detail in the three-day congress through member, free paper and special sessions as well as the pre-congress meetings, which included the African Regional meeting, hosted by the National Department of Health of South Africa.
Erik Normann, IHF President, in his opening remarks, expressed his delight at the fact that the Durban Congress was the first to be hosted by IHF on the African continent since the creation of the IHF in 1929.
Apart from addressing the challenges and delivering interesting and trending healthcare topics, the congress has also made sure that all the events and activities held would make a difference in patient-centred care by featuring cutting-edge delivery approaches and inventive management practices.
Aligned with those innovative healthcare management practices, IHF members and delegates had unique opportunities to exhibit and share their accomplishments and practices in hospital leadership to the global healthcare community through expositions.
The IHF CEO Circle, the exclusive professional network for senior healthcare executives was also highlighted in the congress through meetings.

IHF 2016 International Awards
The IHF 2016 International Awards attracted many excellence entries from 19 countries. The Awards, given to hospitals, not individuals, because healthcare is acknowledged as a team endeavour, recognize achievements in several areas, such as quality and patient safety, corporate social responsibility, innovations in service delivery at affordable costs, and healthcare leadership and management practices.

In the last day of the event, the delegates were also given the chance to visit and tour some of the distinguished hospitals and healthcare facilities in Durban, South Africa which included: KZN Children’s Hospital, Ethekwini Hospital and Heart Centre, Inkosi Albert Luthuli Central Hospital, King Dinuzulu Hospital, and Prince Mshiyeni Memorial Hospital.
All the mentioned activities and events of this year’s World Hospital Congress show its key unique features on how it can contribute and respond to the needs in the global healthcare nowadays.
Delegates were already looking forward to attending next year’s congress, the IHF 41st World Hospital Congress, which will take place 7-9 November 2017 in Taipei, Taiwan, with the theme ‘Patient-friendly and Smarter Healthcare’.
The IHF World Hospital Congress, being held annually, is a unique global forum’ and a one-stop shop’ for the healthcare professionals in quest of an unparalleled environment to exchange insights, experiences, and expertise in the sector of health management and service delivery.
IHF having as a mission to enhance knowledge that can translate into practice for those having the responsibilities to lead healthcare organizations is making available all the resources that were shared during this congress.
A selection of Congress presentations appears on pages 15-17 of this issue of International Hospital.

www.ihf-fih.org

A team of Mayo Clinic researchers has, for the first time, successfully mapped patterns of prostate cancer recurrence, following surgery. Using C-11 choline PET imaging and multi-parametric MRI, researchers found an anatomically diverse pattern of recurrence, which may help optimize treatment of patients whose prostate cancer returns after surgery.
‘This study has important implications for men who have a rising prostate-specific antigen (PSA) test, also known as biochemical recurrence, after radical prostatectomy for prostate cancer,’ says Jeffrey Karnes, M.D., a urological surgeon at Mayo Clinic. ‘In men with biochemical recurrence, determining where the disease has recurred is quite challenging, especially when the PSA level is low.’
According to Dr. Karnes, in the U.S., approximately 30 percent of patients who have had an initial prostate cancer surgically excised will suffer a recurrence and seek treatment. ‘Current imaging tests like conventional bone and CT scans are not sensitive enough to identify sites of recurrence, especially when the PSA value is lower than 10,’ he says.
Dr. Karnes says the combination of C-11 choline PET scanning and multiparametric MRI, helps physicians accurately identify sites of recurrence at an average PSA of 2. More importantly, he says, ‘This type of staging allows us to identify sites of recurrent disease that can be potentially treated either surgically or with radiation.’
Dr. Karnes and his team also were able to describe patterns of prostate cancer recurrence. They found that nearly two-thirds of men in the study had recurrence limited to the pelvis, which potentially can be targeted for radiation therapy.

Mayo Clinic http://tinyurl.com/h9ot93x