Journal and News Scan

Data from the National Lung Screening Trial (NLST) were examined by exploring different size thresholds for classifying CT screening scans as positive.  In the NLST, nearly two-thirds of nodules were 7mm in diameter or less.  Using a threshold of 5mm, the percentage of missed/delayed diagnosis and the likelihood of avoiding false positive findings were 1% and 16%.  Using a threshold of 8mm increased those rates to 11% and 66%.  Increasing size thresholds reduced follow-up CTs and invasive procedures.  Interestingly, differences in thresholds did not affect survival or mortality.

301 pts with CAD required revascularization and moderate MR were randomly assigned to CABG or CABG with MV repair.  The outcome was LV end-systolic index at 1 year.  MV repair contributed to longer pump times, longer hospitalization, and more neurologic events.  MV repair did not result in an improved primary outcome at 1 year, but was associated with reduced rates of moderate to severe MR.  The potential benefit of this latter finding is unclear.

This trial randomized 900 pts with type 1 or 2 diabetes to screening with coronary computed tomography angiography (CCTA) or standard care and evaluated death and non-fatal coronary outcomes.  The major outcome was a composite of death, MI, and admission for management of unstable angina.  The secondary outcome was a composite of CAD-associated death, MI, or unstable angina.  CCTA screening did not influence the rate of major or secondary outcomes.

The authors aimed to study whether systemic lupus erythematosus (SLE) resulted in an increased risk of congenital heart defects (CHD). Mothers with SLE were selected from a large Quebec healthcare database and matched to mothers without SLE. Children born to mothers with SLE were more likely to experience CHD (5.2% versus 1.9%). The odds ratio in a multivariable model was 2.62 (95% CI, 1.77-3.88). Moreover, children born to mothers with SLE also had an increased risk of a CHD repair procedure.