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1.  Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial 
Newby, David E | Williams, Michelle C | Flapan, Andrew D | Forbes, John F | Hargreaves, Allister D | Leslie, Stephen J | Lewis, Steff C | McKillop, Graham | McLean, Scott | Reid, John H | Sprat, James C | Uren, Neal G | van Beek, Edwin J | Boon, Nicholas A | Clark, Liz | Craig, Peter | Flather, Marcus D | McCormack, Chiara | Roditi, Giles | Timmis, Adam D | Krishan, Ashma | Donaldson, Gillian | Fotheringham, Marlene | Hall, Fiona J | Neary, Paul | Cram, Louisa | Perkins, Sarah | Taylor, Fiona | Eteiba, Hany | Rae, Alan P | Robb, Kate | Barrie, Dawn | Bissett, Kim | Dawson, Adelle | Dundas, Scot | Fogarty, Yvonne | Ramkumar, Prasad Guntur | Houston, Graeme J | Letham, Deborah | O’Neill, Linda | Pringle, Stuart D | Ritchie, Valerie | Sudarshan, Thiru | Weir-McCall, Jonathan | Cormack, Alistair | Findlay, Iain N | Hood, Stuart | Murphy, Clare | Peat, Eileen | Allen, Barbara | Baird, Andrew | Bertram, Danielle | Brian, David | Cowan, Amy | Cruden, Nicholas L | Dweck, Marc R | Flint, Laura | Fyfe, Samantha | Keanie, Collette | MacGillivray, Tom J | Maclachlan, David S | MacLeod, Margaret | Mirsadraee, Saeed | Morrison, Avril | Mills, Nicholas L | Minns, Fiona C | Phillips, Alyson | Queripel, Laura J | Weir, Nicholas W | Bett, Fiona | Divers, Frances | Fairley, Katie | Jacob, Ashok J | Keegan, Edith | White, Tricia | Gemmill, John | Henry, Margo | McGowan, James | Dinnel, Lorraine | Francis, C Mark | Sandeman, Dennis | Yerramasu, Ajay | Berry, Colin | Boylan, Heather | Brown, Ammani | Duffy, Karen | Frood, Alison | Johnstone, Janet | Lanaghan, Kirsten | MacDuff, Ross | MacLeod, Martin | McGlynn, Deborah | McMillan, Nigel | Murdoch, Laura | Noble, Colin | Paterson, Victoria | Steedman, Tracey | Tzemos, Nikolaos
Trials  2012;13:184.
Background
Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic.
Methods/design
The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014.
Discussion
This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease.
Trial registration
ClinicalTrials.gov Identifier: NCT01149590
doi:10.1186/1745-6215-13-184
PMCID: PMC3667058  PMID: 23036114
Computed tomography; Coronary heart disease; Rapid access chest pain clinic
2.  Walking speed and subclinical atherosclerosis in healthy older adults: the Whitehall II study 
Heart  2010;96(5):380-384.
Objective
Extended walking speed is a predictor of incident cardiovascular disease (CVD) in older individuals, but the ability of an objective short-distance walking speed test to stratify the severity of preclinical conditions remains unclear. This study examined whether performance in an 8-ft walking speed test is associated with metabolic risk factors and subclinical atherosclerosis.
Design
Cross-sectional.
Setting
Epidemiological cohort.
Participants
530 adults (aged 63±6 years, 50.3% male) from the Whitehall II cohort study with no known history or objective signs of CVD.
Main outcome
Electron beam computed tomography and ultrasound was used to assess the presence and extent of coronary artery calcification (CAC) and carotid intima-media thickness (IMT), respectively.
Results
High levels of CAC (Agatston score >100) were detected in 24% of the sample; the mean IMT was 0.75 mm (SD 0.15). Participants with no detectable CAC completed the walking course 0.16 s (95% CI 0.04 to 0.28) faster than those with CAC ≥400. Objectively assessed, but not self-reported, faster walking speed was associated with a lower risk of high CAC (odds ratio 0.62, 95% CI 0.40 to 0.96) and lower IMT (β=−0.04, 95% CI −0.01 to −0.07 mm) in comparison with the slowest walkers (bottom third), after adjusting for conventional risk factors. Faster walking speed was also associated with lower adiposity, C-reactive protein and low-density lipoprotein cholesterol.
Conclusions
Short-distance walking speed is associated with metabolic risk and subclinical atherosclerosis in older adults without overt CVD. These data suggest that a non-aerobically challenging walking test reflects the presence of underlying vascular disease.
doi:10.1136/hrt.2009.183350
PMCID: PMC2921267  PMID: 19955091
Ageing; atherosclerosis; computed tomography scanning; epidemiology; exercise testing; gait speed; imaging; physical function; risk stratification

Results 1-2 (2)