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Angiotensin-converting enzyme Cox proportional hazards models, we compared the prog- inhibitors or angiotensin II receptor blockers were used nostic power of LVMI and Strain Table 3. These used diuretics. General characteristics of the studied popu- associations remained significant after the adjustments for lation are summarized in Table 1.

When LVMI and Strain were included in the same model, only Strain remained signifi- cantly associated with the studied outcomes. Clinical, Laboratorial, and Echocardiographic Characteristics According to the Strain Combined Use of LVMI and Strain in Prognosis Phenotype As LVMI and Strain may provide additional prognostic Although there were no differences in the use of single information, we assessed the ability of the combination of antihypertensive drugs, patients with Strain were using these conditions to better stratify the risk for adverse out- more antihypertensive drugs.

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They also presented a higher comes. In addition, they also had a higher inflammatory groups by defining high LVMI as above the gender- status ie, lower albumin and higher CRP levels , as well as specific median values in this population. The italic values indicate statistical significance. Adjusted model 2 1. Presence of Strain 3. Adjusted model 2 3. C-reactive protein and left atrium diameter. This association remained after the adjust- z LVMI was available in patients in whom the number of ment for potential confounders.

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This analysis comprised all individuals and utilized LVMI as a continuous variable. Figure 2. Kaplan-Meyer curves for a composite endpoint of death and cardiovascular events Panel A or cardiovascular events alone fatal and non-fatal; Panel B according to the presence of the electrocardiographic strain pattern in chronic kidney disease CKD stages 3 to 5 patients. Kaplan-Meyer curves for a composite endpoint of death and cardiovascular events Panel A or cardiovascular events alone fatal and non-fatal; Panel B according to the combined presence of high left ventricular mass index LVMI and the electrocardio- graphic strain pattern in chronic kidney disease CKD stages 3 to 5 patients.

Although not statistically significant, patients with Strain CKD patients, which is in agreement and reinforces previ- exhibited a trend towards higher blood pressure and were ous studies in the general population. This is well with previous community data,20,24 those with ECG in line with a previous report in non-CKD hypertensive strain pattern in our study also had a higher prevalence of patients where Strain individuals were also in need of peripheral vascular disease, which may reflect a greater more aggressive antihypertensive therapy.

Altogether, these findings support the concept index that patients with LVH may be at an increased risk for inci- The italic values indicate statistical significance. Reliability of electrocardio- other population groups,8,10,11,20,21,24,40 the presence of graphic surrogates of left ventricular mass in patients with Strain was associated with a nearly three-fold increase in chronic kidney disease. J Hypertens ;— Electrocardiographic left ventricular hypertrophy dent of LVMI in itself, it is possible that Strain may capture and outcome in hemodialysis patients.

PLoS One a different or additional risk. In fact, this pattern has been ;7:e Combined echocardio- community level. Hyperten- use of Strain as a complementary risk identification tool sion ;— Prognostic value of a some caution, bearing in mind that this is a single-center new electrocardiographic method for diagnosis of left study with a relatively small sample size, as well as a ventricular hypertrophy in essential hypertension.

J reduced number of events, which may impact on the test Am Coll Cardiol ;— In addition, the investigated patient Prognostic value cohort was recruited by a nephrology team linked to a car- of electrocardiographic criteria for left ventricular hy- diology unit, and presumably has a higher prevalence of pertrophy.

Am Heart J ;—7. Thus, Prevalence and prog- populations. The identification of Strain depends on the nosis of electrocardiographic left ventricular hypertro- reliability of the observer, but nevertheless, our results sug- phy, ST segment depression and negative T-wave; the gest that the easy identification of this ECG pattern in Copenhagen City Heart Study.

Eur Heart J ; routine screening may allow early identification of sub- — Visceral fat to implement more aggressive and focused treatment.

Nephrol Dial Transplant ;28 Suppl 4 :iv—9. References Seventh report of the Joint 1. Clinical epidemi- National Committee on Prevention, Detection, Evalua- ology of cardiovascular disease in chronic renal dis- tion, and Treatment of High Blood Pressure.

Hyperten- ease. Clinical and echocardio- new method of classifying prognostic comorbidity in graphic disease in patients starting end-stage renal dis- longitudinal studies: development and validation. J ease therapy. Kidney Int ;— Chronic Dis ;— Recommendations for population: identifying opportunities for intervention. Prognostic impact of Group, developed in conjunction with the European the indexation of left ventricular mass in patients under- Association of Echocardiography, a branch of the Euro- going dialysis.

J Am Soc Nephrol ;— J Am Soc Echocardiogr 5. Huang JC, et al. The ratio of observed to predicted Exten- left ventricular mass is independently associated with sions of net reclassification improvement calculations increased cardiovascular events in patients with chronic to measure usefulness of new biomarkers. Stat Med kidney disease. Hypertens Res ;—8.

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Fabry is an inherited disease affecting about 10, people worldwide in which a genetic mutation stops an enzyme from breaking down a fatty substance known as globotriaosylceramide, or GL3. The buildup of GL3 in blood vessels throughout the body causes severe damage to kidneys, heart, brain, and other organ systems. In the Amicus study, Fabry patients who were switched to migalastat, a pill taken every other day, from Fabrazyme or Replagal showed a statistically significant decrease in left ventricular mass index LVMi compared to patients who remained on the injectable therapies after 18 months.

LVMi measures the size of the heart. Fabry patients often have enlarged hearts, which leads to cardiovascular complications and death. Approximately one-third of the Fabry patients entered the study with abnormal LVMi measurements.

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The percentage of these patients achieving normal LVMi levels after 18 months was not disclosed. The Fabry patients in the study continue to be followed to determine if improvements in LVMi lead to lower incidences of cardiovascular adverse events or death, said Amicus CEO John Crowley.

On all the components of the Fabry-associated clinical events score -- cardiac, kidney and central nervous system -- migalastat-treated patients reported fewer events than the injectable therapies. You can benefit from national defense without paying for it, so you might as well pretend to have less interest in it than you truly do false signal. Therefore, taxation should be compulsory.

But then Samuelson simply assumed that planners would do an adequate job of correctly guessing your true valuation of defense. He assumed omniscience. Did she mention anything about the fact that the biggest economic defense of our current system of government is based on the assumption that planners are omniscient? But when it came to his assumption of omniscience, Buchanan had a very big issue. He argued that taxpayer earmarking would eliminate the incentive to give false signals.

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Since you are paying taxes anyways, if you were given the opportunity to earmark your taxes, then the amount of your tax dollars that you earmarked to defense would accurately reflect your valuation of defense. His work is inspired by his very serious concern about the assumption of omniscience.

No economist in their right mind is going to argue for voting on the amount of money to spend on defense. Because if that was sane, then we might as well vote on the amount of money to spend on milk. Except, if voting is used to allocate all resources, then money itself would be pointless. Buchanan is our Goliath. MacLean is not your David. But at least she tried. Wikipedia, under its category tags, puts IHS, among other things, in the category of … wait for it, wait for it ….

Just saying. I know other professors who have no problem using Wikipedia, properly understood and used. There is undoubtedly a decent paper to be written about this separation. MacLean uses some of her first royalty cheque to buy a bottle of wine for each of her most ardent critics. The lifeblood of any argument depends on its circulation, and her critics have made sure that her book generates conversation.

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Thanks to Maclean and a few others, I perceive the field as I imagine other non-practitioners of phrenology perceive that field.