RESUMEN
BACKGROUND: Medical infrared thermal imaging (MITI) is a noninvasive imaging modality used in veterinary medicine as a screening tool for musculoskeletal and neurological disease processes. An infrared camera measures the surface body heat and produces a color map that represents the heat distribution. Local trauma or disease can impair the autonomic nervous system, which leads to changes in the local dermal microcirculation and subsequent alteration of surface body heat. Disruption of autonomic flow to the cutaneous vasculature at deeper levels can also result in asymmetric thermographic results. The purpose of this study was to evaluate surface temperature differences between limbs affected by bone neoplasia and their normal contralateral limbs. RESULTS: A statistically significant difference in average temperature was noted between regions of interest of the two groups (paired difference: 0.53 C° ± 0.14; P = 0.0005). In addition, pattern recognition analysis yielded a 75-100% success rate in lesion identification. CONCLUSIONS: Significant alterations noted with average temperature and thermographic patterns indicate that MITI can document discernible changes associated with the presence of canine appendicular bone tumors. While MITI cannot be used as the sole diagnostic tool for bone cancer, it can be used as a screening modality and may be applicable in early detection of cancer.
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Neoplasias Óseas/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Extremidades/diagnóstico por imagen , Animales , Neoplasias Óseas/diagnóstico por imagen , Perros , Femenino , Procesamiento de Imagen Asistido por Computador , Masculino , Reconocimiento de Normas Patrones Automatizadas , Estudios Prospectivos , Termografía/métodos , Termografía/veterinariaRESUMEN
PURPOSE: To compare cardiovascular magnetic resonance-feature tracking (CMR-FT) with spatial modulation of magnetization (SPAMM) tagged imaging for the calculation of short and long axis Lagrangian strain measures in systole and diastole. MATERIALS AND METHODS: Healthy controls (n = 35) and patients with dilated cardiomyopathy (n = 10) were identified prospectively and underwent steady-state free precession (SSFP) cine imaging and SPAMM imaging using a gradient-echo sequence. A timed offline analysis of images acquired at identical horizontal long and short axis slice positions was performed using CMR-FT and dynamic tissue-tagging (CIMTag2D). Agreement between strain and strain rate (SR) values calculated using these two different methods was assessed using the Bland-Altman technique. RESULTS: Across all participants, there was good agreement between CMR-FT and CIMTag for calculation of peak systolic global circumferential strain (-22.7 ± 6.2% vs. -22.5 ± 6.9%, bias 0.2 ± 4.0%) and SR (-1.35 ± 0.42 1/s vs. -1.22 ± 0.42 1/s, bias 0.13 ± 0.33 1/s) and early diastolic global circumferential SR (1.21 ± 0.44 1/s vs. 1.07 ± 0.30 1/s, bias -0.14 ± 0.34 1/s) at the subendocardium. There was satisfactory agreement for derivation of peak systolic global longitudinal strain (-18.1 ± 5.0% vs. -16.7 ± 4.8%, bias 1.3 ± 3.8%) and SR (-1.04 ± 0.29 1/s vs. -0.95 ± 0.32 1/s, bias 0.09 ± 0.26 1/s). The weakest agreement was for early diastolic global longitudinal SR (1.10 ± 0.40 1/s vs. 0.67 ± 0.32 1/s, bias -0.42 ± 0.40 1/s), although the correlation remained significant (r = 0.42, P < 0.01). CMR-FT generated these data over four times quicker than CIMTag. CONCLUSION: There is sufficient agreement between systolic and diastolic strain measures calculated using CMR-FT and myocardial tagging for CMR-FT to be considered as a potentially feasible and rapid alternative.
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Cardiomiopatía Dilatada/fisiopatología , Diagnóstico por Imagen de Elasticidad/métodos , Ventrículos Cardíacos/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Cinemagnética/métodos , Disfunción Ventricular/fisiopatología , Adulto , Cardiomiopatía Dilatada/complicaciones , Diástole , Módulo de Elasticidad , Humanos , Aumento de la Imagen/métodos , Persona de Mediana Edad , Reconocimiento de Normas Patrones Automatizadas/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resistencia al Corte , Estrés Mecánico , Sístole , Disfunción Ventricular/etiologíaRESUMEN
Heart failure (HF) is a syndrome and not a diagnosis. Aetiology and precipitants for decompensation are often not sought. Care is also often based upon protocols, with widespread prescription of drugs validated in systolic HF, for patients with other forms of HF for example HF with preserved ejection fraction which can account for almost half of patients with HF in the UK. Therefore, service design and configuration by healthcare providers should based upon quality and not only feasibility, as protocol-based treatment will inevitably diminish the quality of care for patients with HF and result in both inappropriate care in many cases as well as reduced access to advanced evidence based and NICE approved therapies. Expertise is therefore of paramount importance in managing patients with HF.
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Insuficiencia Cardíaca/diagnóstico , Ecocardiografía , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/etiología , HumanosRESUMEN
The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.
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Servicios Médicos de Urgencia/métodos , Telemedicina/organización & administración , Telemetría/métodos , Heridas y Lesiones/terapia , Humanos , Evaluación de Programas y Proyectos de Salud/métodos , Centros TraumatológicosRESUMEN
Salmonella is one of the most frequently reported etiological agents in outbreaks of foodborne diseases associated with the consumption of cantaloupes. Sensitive and reliable methods for detecting and identifying foodborne microorganisms are needed. The PCR can be used to amplify specific DNA fragments and thus to detect and identify pathogenic bacteria. In this study, a PCR method was used to evaluate the incidence of Salmonella at cantaloupe production, harvest, and packaging steps, and the results were compared with those of the standard method for detection of Salmonella in foods (Mexican NOM-114-SSA1-1994). Salmonella was detected by both standard and PCR methods in 23.5% of the irrigation water samples but only by the PCR method in 9.1% of the groundwater samples, 4.8% of the chlorinated water samples, 16.7% of samples from the hands of packing workers, 20.6% of samples from the packed cantaloupes, and 25.7% of samples from the in-field cantaloupes. With the standard method, Salmonella was found in 8.3% of the crop soil samples. Statistical analysis indicated a significant difference in sensitivity (P < 0.05) between the two methods; the PCR method was 4.3 times more sensitive than the standard method. Salmonella was found at seven of the eight pointsevaluated during the production and postharvest handling of cantaloupe melons.
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Cucumis melo/microbiología , ADN Bacteriano/análisis , Contaminación de Alimentos/análisis , Reacción en Cadena de la Polimerasa/métodos , Salmonella/aislamiento & purificación , Seguridad de Productos para el Consumidor , Microbiología de Alimentos , Embalaje de Alimentos/normas , Industria de Procesamiento de Alimentos/normas , Amplificación de Genes , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: We attempted to assess insulin sensitivity in patients with chronic heart failure (CHF) and its relation to disease severity. BACKGROUND: Peripheral muscular changes influence the progression of heart failure. This effect may be due to chronic disturbances of insulin and glucose metabolism that affect the energy status of skeletal and myocardial muscle. METHODS: We investigated insulin sensitivity in 79 men-38 patients with CHF, 21 patients with angiographic evidence of coronary artery disease without CHF and 20 healthy control subjects-and assessed its relation to disease severity, etiology and hormonal status (all subjects had a similar age and body mass index). Insulin sensitivity was estimated by minimal modeling analysis of the glucose and insulin and profiles during a 0.5 g/kg body weight intravenous glucose tolerance test. RESULTS: Compared with control subjects, patients with CHF had similar mean fasting glucose but increased insulin levels (67 vs. 29 pmol/liter, p < 0.002) and a 58% reduced mean insulin sensitivity (2.01 vs. 4.84 min-1/pmol/ml x 10(5), p < 0.0001). Peak oxygen consumption (VO2) (r = 0.63), fasting triglycerides (r = -0.62) and age (r = -0.46, all p < 0.001) predicted insulin sensitivity independently. Rest norepinephrine and epinephrine levels, left ventricular ejection fraction and heart failure etiology were not related to insulin sensitivity. Patients with coronary artery disease but no CHF had an intermediate mean insulin sensitivity (3.30 min-1/pmol/ml x 10(5) [-32%, p = 0.042 vs. control subjects; +113%, p = 0.0023 vs. patients with CHF due to ischemic heart disease]). In multivariate analyses of all 79 subjects, age (p = 0.0006), triglycerides (p = 0.0023), fasting insulin (p = 0.0037) and the presence of CHF (p = 0.018) were independent predictors of impaired insulin sensitivity (adjusted joint R2 = 0.53, p < 0.0001). CONCLUSIONS: CHF is associated with marked insulin resistance, characterized by both fasting and stimulated hyperinsulinemia. Advanced heart failure (in terms of reduced peak VO2) is related to increased insulin resistance, but this is not directly mediated through ventricular dysfunction or increased catecholamine levels.
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Insuficiencia Cardíaca/sangre , Resistencia a la Insulina , Glucemia/análisis , Enfermedad Coronaria/sangre , Epinefrina/sangre , Prueba de Tolerancia a la Glucosa , Insuficiencia Cardíaca/etiología , Humanos , Insulina/sangre , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Consumo de Oxígeno , Triglicéridos/sangreRESUMEN
The objective of this study was to evaluate the medication pattern of febrile patients and determine what proportion of these drugs were included in the Mexican Essential Drugs List. A cross-sectional study was conducted in 32 rural communities located in malarial endemic areas near the Mexico-Guatemala border. Of 817 febrile patients interviewed, 55% self-medicated, while 16% consulted a physician. The most frequently used drugs were antipyretics (68%), antibiotics (25%), and antimalarial drugs (37%), despite the fact that only 2% of all febrile patients were diagnosed with malaria. Antipyrine, acetylsalicylic acid, and acetaminophen represented 84% of antipyretics, and ampicillin, penicillin, and sulfadiazine-trimethoprim represented 51% of total antibiotics. Public health service and self-medicating patients used essential drugs (antipyretics and antibiotics) significantly more than those consulting private physicians. These findings demonstrate the need to foster access to primary health care (PHC) facilities, rational drug prescription by private physicians, and to review guidelines for prescription of antimalarial drugs for febrile patients.
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Fiebre/tratamiento farmacológico , Población Rural , Antibacterianos/uso terapéutico , Antimaláricos/uso terapéutico , Estudios Transversales , Utilización de Medicamentos , Humanos , México/epidemiologíaRESUMEN
Bronchoalveolar lavage (BAL) has proved valuable in the diagnosis of pulmonary complications in immunosuppressed patients. We evaluated the diagnostic yield of BAL in pulmonary complications in bone marrow transplantation (BMT) recipients. We reviewed sequentially the records of 89 patients during an 18-month period. BAL was diagnostic in 42 patients (47%). The most common pulmonary complication diagnosed by BAL was diffuse alveolar hemorrhage (n = 15); followed by bacterial pneumonia (n = 10), respiratory syncytial virus (n = 8), aspergillosis (n = 6), Pneumocystis carinii pneumonia (n = 5), cytomegalovirus (CMV) (n = 4), and others (n = 4). The final diagnoses in the BAL non-diagnostic group were: bacterial pneumonia (n = 6), CMV (n = 6), idiopathic pneumonia syndrome (n = 5), cancer recurrence (n = 4), cardiogenic pulmonary edema (n = 4), and others (n = 9). We conclude that BAL is a useful diagnostic tool in BMT-related pulmonary complications.
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Trasplante de Médula Ósea/efectos adversos , Lavado Broncoalveolar , Enfermedades Pulmonares/diagnóstico , Estudios Transversales , Humanos , Enfermedades Pulmonares/etiologíaRESUMEN
Elevations in circulating levels of both endothelin-1 (ET-1) and insulin are found in coronary heart disease and chronic heart failure. Although several studies have shown that insulin can stimulate ET-1 release from endothelial cell cultures, in vivo studies have yielded equivocal results. We sought to determine whether endogenous insulin at physiological concentrations leads to alterations in venous plasma ET-1 levels in healthy subjects. In addition, we investigated the effects of physiological and supraphysiological doses of insulin on the release of ET-1 from human umbilical vein endothelial cells (HUVECs) in vitro. In the in vitro experiment, ET-1 and insulin levels were measured during an intravenous glucose tolerance test (IVGTT) in 10 healthy subjects. In the in vitro experiment, HUVECs were incubated in the absence of serum and with different concentrations of insulin (25 pmol/L to 1 mumol/L) for 4 hours before measurement of secreted ET-1. The in vivo study showed no significant alterations in venous plasma ET-1 levels during IVGTTs (maximum plasma insulin, 616.9 +/- 147.0 pmol/L [mean +/- SEM]). In the in vitro experiment, increases in ET-1 release were observed under serum-free conditions at 100 pmol/L (physiological) and 1 mumol/L (supraphysiological) insulin (ET-1, 22.4% and 46.4% higher than control cultures, respectively, both P < .05). Our results show that insulin at physiological concentrations does not alter plasma ET-1 levels in healthy individuals, but does stimulate its secretion from vascular endothelial cells in vitro. This may have implications for the study of elevated ET-1 in hyperinsulinemic states.
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Endotelina-1/biosíntesis , Endotelina-1/sangre , Endotelio Vascular/metabolismo , Hiperinsulinismo , Insulina/sangre , Insulina/farmacología , Glucemia/metabolismo , Células Cultivadas , Carbohidratos de la Dieta , Endotelio Vascular/citología , Endotelio Vascular/efectos de los fármacos , Ayuno , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Venas UmbilicalesRESUMEN
Coronary heart disease (CHD) is pathogenetically linked to numerous metabolic disturbances. These are inextricably interrelated, constituting identifiable clusters or syndromes of cardiovascular risk. Prominent among these is the insulin resistance syndrome, whose components, including hyperuricemia, have all been linked to CHD pathogenesis. Many mechanisms have been put forward to account for the emergence of this syndrome, but none offer a satisfactory explanation for the involvement of hyperuricemia. Possible explanations relate to the observation of glycolytic disturbances in insulin-resistant and hyperuricemic states. This might be expected from the fact that uric acid production is linked to glycolysis and that glycolysis is controlled by insulin. Phosphoribosylpyrophosphate (PPRP) is an important metabolite in this respect. Its availability depends on ribose-5-phosphate (R-5-P), the production of which is governed by glycolytic flux. Diversion of glycolytic intermediates toward R-5-P, PPRP, and uric acid will follow if there is diminished activity of glyceraldehyde-3-phosphate dehydrogenase (GA3PDH), which is regulated by insulin. Serum triglyceride concentrations may also increase, as might be expected from accumulation of glycerol-3-phosphate. Thus, intrinsic defects in GA3PDH and a loss of its responsiveness to insulin, by causing accumulation of glycolytic intermediates, may explain the association between insulin resistance, hyperuricemia, and hypertriglyceridemia. This scenario raises the possibility that disturbances of a single glycolytic enzyme may be pivotal in the modulation of metabolic risk factors for CHD.
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Enfermedad Coronaria/etiología , Glucólisis/fisiología , Modelos Biológicos , Animales , Gliceraldehído-3-Fosfato Deshidrogenasas/metabolismo , Humanos , Hipertrigliceridemia/metabolismo , Ácido Úrico/sangre , Ácido Úrico/metabolismoRESUMEN
The anaerobic threshold (AT) is a measure of the balance between aerobic and anaerobic cellular metabolism. Hyperuricemia occurs in conditions that involve an imbalance between cellular oxygen consumption and carbon dioxide production, such as chronic heart failure (CHF). We therefore hypothesized that in CHF, serum uric acid might be related to the AT. Patients with CHF (n=40, aged 58.7+/-1.9 years; New York Heart Association Class I-IV; maximal oxygen consumption [MVO2], 18.7+/-01.1 mL/kg/min; left ventricular ejection fraction, 26%+/-2%) and 10 age-matched healthy controls underwent measurement of the serum uric acid level at rest and assessment of the AT. This was derived from MVO2 and the regression slope relating minute ventilation to carbon dioxide output (VE - VCO2) during a maximal treadmill exercise test. Compared with the healthy controls, patients with CHF had a lower AT (11.8+/-0.7 v 16.9+/-1.1 mL/kg/min, P < .001) and a higher serum uric acid concentration (493.8+/-22.4 v 308.7+/-21.5 micromol/L, P < .001). In univariate analyses of the CHF group, the AT correlated with serum uric acid (r=-.56, P < .001; AT=19.93 - (0.016 x uric acid), R2=.31, P < .001) and plasma creatinine (r=-.43, P < .01), but not with the diuretic dose. In stepwise regression analyses of the CHF group, serum uric acid emerged as a predictor of the AT (standardized coefficient=-.56, P < .001), whereas the diuretic dose and plasma creatinine failed to enter into the final models (multiple R2=.31, P < .001). In conclusion, in CHF there is an inverse relationship between the AT and the resting serum uric acid concentration. This is consistent with the known links between uric acid production and the imbalance in aerobic/anaerobic metabolism that occur in CHF. These findings provide the basis for using the simple measurement of the serum uric acid level as a surrogate measure of the AT.
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Insuficiencia Cardíaca/metabolismo , Ácido Úrico/sangre , Anaerobiosis , Presión Sanguínea , Enfermedad Crónica , Humanos , Persona de Mediana Edad , Análisis MultivarianteRESUMEN
OBJECTIVE: To compare the cultures of tonsillar surface aerobic and anaerobic bacterial flora taken during the acute phase of infectious mononucleosis with the repeated cultures taken 2 months later. PATIENTS: Fourteen patients with pharyngotonsillitis associated with infectious mononucleosis. RESULTS: A total of 121 bacterial isolates (ie, 84 anaerobes and 37 facultatives and aerobes) were isolated in the acute stage, and 75 isolates (ie, 42 anaerobes and 33 aerobes) were recovered 2 months later. The reduction in the number of organisms in the second specimen was mostly due to the decrease in the recovery of Prevotella intermedia (13 in the first culture, compared with four in the second) and Fusobacterium nucleatum (12 vs four, respectively). CONCLUSIONS: The study illustrates that the surfaces of tonsils of patients with infectious mononucleosis contain more species of anaerobic organisms during the illness than following it. The potential role of these organisms in the inflammation process warrants further study.
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Bacterias Anaerobias/aislamiento & purificación , Mononucleosis Infecciosa/microbiología , Tonsila Palatina/microbiología , Adolescente , Adulto , Bacterias Aerobias/aislamiento & purificación , Niño , Femenino , Humanos , Inmunoglobulina G/inmunología , Mononucleosis Infecciosa/complicaciones , Mononucleosis Infecciosa/diagnóstico , Masculino , Faringe/microbiología , Tonsilitis/complicaciones , Tonsilitis/microbiología , beta-Lactamasas/metabolismoRESUMEN
OBJECTIVE: To determine whether lower limb blood flow is related to serum uric acid concentrations in patients with chronic heart failure, taking into account the hyperuricaemic effects of diuretic treatment and insulin resistance. DESIGN: Lower limb blood flow was measured at rest and after maximum exercise followed by a five minute period of ischaemia (maximum blood flow) using strain gauge venous occlusion plethysmography. All patients underwent a metabolic assessment, which included an intravenous glucose tolerance test (IVGTT)-to obtain an index of insulin sensitivity- and measurement of serum uric acid. SETTING: University and hospital departments specialising in cardiology and metabolic medicine. SUBJECTS: 22 patients with chronic heart failure. RESULTS: Mean (SEM) resting and maximum blood flow values were 2.87 (0.23) and 24.00 (1.83) ml/100 ml/min, respectively. Patients in the upper tertile of serum uric acid had lower maximum blood flow than those in the lowest tertile (15.6 (2.2) v 31.0 (2.1) ml/100 ml/min, P = 0.003). Serum uric acid correlated with maximum blood flow (r = -0.86, P < 0.001), but not with resting blood flow. In stepwise regression analysis, uric acid emerged as the only predictor of maximum blood flow (standardised coefficient = -0.83 (P < 0.001), R2 = 0.68 (P < 0.001)), independently of diuretic dose, age, body mass index, plasma creatinine, fasting and IVGTT glucose and insulin, insulin sensitivity, maximum oxygen uptake and exercise time during the treadmill exercise test, and alcohol intake. CONCLUSIONS: There is a strong inverse relation between serum uric acid concentrations and maximum leg blood flow in patients with chronic heart failure. Further studies are needed to determine whether serum uric acid can be used as an index of vascular function in cardiovascular diseases.
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Insuficiencia Cardíaca/fisiopatología , Pierna/irrigación sanguínea , Ácido Úrico/sangre , Biomarcadores/sangre , Glucemia/metabolismo , Diuréticos/administración & dosificación , Prueba de Esfuerzo , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Insulina/sangre , Persona de Mediana Edad , Oxígeno/sangre , Valor Predictivo de las Pruebas , Flujo Sanguíneo Regional , Análisis de RegresiónAsunto(s)
Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/prevención & control , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Interpretación Estadística de Datos , Progresión de la Enfermedad , Ecocardiografía , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Sesgo de Selección , Índice de Severidad de la EnfermedadRESUMEN
AIMS: The cardinal symptom of heart failure with a normal ejection fraction (HFNEF) is exertional dyspnoea. The authors hypothesised that failure of left atrial (LA) compensatory mechanism particularly on exercise contributes to the genesis of symptoms in HFNEF patients. METHODS AND RESULTS: Fifty HFNEF patients, 15 asymptomatic hypertensive subjects and 30 healthy controls underwent rest and submaximal exercise echocardiography. Rest and exercise systolic, early diastolic and late diastolic (Am) mitral annular velocities were assessed using colour tissue Doppler echocardiography. Left atrial functional reserve index was calculated. Am at rest was comparable between all three groups, but exercise Am was significantly lower in HFNEF compared with hypertensive subjects and healthy controls resulting in a lower LA functional reserve index (0.84 (1.34) vs 2.39 (1.27) and 1.81 (1.39), p<0.001). LA volume index was significantly higher in HFNEF patients (30.4 (9.2) vs 27.9 (6.3) and 23.2 (7.1) ml/m(2), p=0.002). There was a significant correlation between Am on exercise with peak VO(2) max (r=0.514, p<0.001) and E/Em on exercise (r=-0.547, p<0.001). Area under the receiver operating characteristic for Am on exercise was 0.768 (95% CI=0.660 to 0.877). CONCLUSION: HFNEF patients have reduced LA function on exercise in addition to left ventricular systolic and diastolic dysfunctions. Reduced LA function probably contributes significantly to exercise intolerance and breathlessness in HFNEF patients.
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Función del Atrio Izquierdo/fisiología , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca Diastólica/fisiopatología , Hipertensión/fisiopatología , Volumen Sistólico/fisiología , Anciano , Estudios de Casos y Controles , Disnea/diagnóstico por imagen , Disnea/etiología , Disnea/fisiopatología , Femenino , Insuficiencia Cardíaca Diastólica/complicaciones , Insuficiencia Cardíaca Diastólica/diagnóstico por imagen , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico por imagen , Masculino , Pruebas de Función Respiratoria , UltrasonografíaAsunto(s)
Antineoplásicos/administración & dosificación , Camptotecina/administración & dosificación , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Aerosoles , Anciano , Antineoplásicos/efectos adversos , Antineoplásicos/farmacocinética , Camptotecina/efectos adversos , Camptotecina/análogos & derivados , Camptotecina/farmacocinética , Esquema de Medicación , Estudios de Factibilidad , Femenino , Humanos , Liposomas , Neoplasias Pulmonares/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To develop and validate a prognostic risk index of cardiovascular mortality after cardiac resynchronisation therapy (CRT). DESIGN: Prospective cohort study. SETTING: District general hospital. PATIENTS: 148 patients with heart failure (mean age 66.7 (SD 10.4) years), New York Heart Association class III or IV, LVEF <35%) who underwent CRT. INTERVENTIONS: CRT device implantation. MAIN OUTCOME MEASURES: Value of a composite index in predicting cardiovascular mortality, validated internally by bootstrapping. The predictive value of the index was compared to factors that are known to predict mortality in patients with heart failure. RESULTS: All patients underwent assessment of 16 prognostic risk factors, including cardiovascular magnetic resonance (CMR) measures of myocardial scarring (gadolinium-hyperenhancement) and dyssynchrony, before implantation. Clinical events were assessed after a median follow-up of 913 (interquartile range 967) days. At follow-up, 37/148 (25%) of patients died from cardiovascular causes. In Cox proportional hazards analyses, (DSC) Dyssynchrony, posterolateral Scar location (both p<0.0001) and Creatinine (p = 0.0046) emerged as independent predictors of cardiovascular mortality. The DSC index, derived from these variables combined, emerged as a powerful predictor of cardiovascular mortality. Compared to patients with a DSC <3, cardiovascular mortality in patients in the intermediate DSC index (3-5; HR: 11.1 (95% confidence interval (CI) 3.00 to 41.1), p = 0.0003) and high DSC index (> or =5; HR: 30.5 (95% CI 9.15 to 101.8), p<0.0001) were higher. Bootstrap validation confirmed excellent calibration and internal validity of the prediction model. CONCLUSION: The DSC index, derived from a standard CMR scan and plasma creatinine before implantation, is a powerful predictor of cardiovascular mortality after CRT.