Measurement of Natriuretic Peptides in Patients with Suspected Heart Failure to Prevent Overuse of Echocardiography - a Pilot Study.

BACKGROUND: European Society of Cardiology (ESC) guidelines recommend measuring natriuretic peptides (BNP or NT-proBNP) in patients with suspected heart failure (HF) as a first-line tool. HF should be ruled-out if concen-trations of NT-proBNP are below 300 ng/L and 125 ng/L for acute HF and chronic HF, respectively. METHODS: Patients with suspected HF referred for transthoracic echocardiography (TTE) were enrolled; NT-pro-BNP concentrations were obtained from medical charts (measurement < 48 hours) or prospectively measured on the day of TTE. RESULTS: Out of 109 patients, NT-proBNP was measured by the referring department before TTE in 40 patients (36.7%), and 37.5% of these patients had NT-proBNP concentration below the rule-out threshold. NT-proBNP was measured in additional 38 patients on the day of TTE. Overall, 38.5% of the patients had a NT-proBNP concentration below the threshold value. CONCLUSIONS: Natriuretic peptides are not routinely measured in patients with suspected HF; systematic measurement would reduce unnecessary TTE by at least 38.5%.

Radiation exposure in interventional cardiology: extremities doses.

X-rays are widely used in interventional cardiology (IC). Medical staff is exposed to ionising radiations with difficulties to accurately estimate the absorbed dose, on the other hand, it is well known that eye lens and extremities are the most exposed. In most IC units, radiological monitoring is performed by measuring the personal dose equivalent with a dosemeter worn under the operator's apron. The ambient dose equivalent is, usually, also measured. Furthermore, doses to the lens and extremities are often not measured because of the absence or difficulty of wearing the appropriate dosemeters. The main aim of our study is to estimate the extremities doses, of the interventional cardiologists, from the personal dose equivalent, the patient's received doses or to the ambient dose equivalent. For this purpose, we use a radiological monitoring, of four (04) interventional cardiologists, carried out at Algiers hospital. A Monte Carlo calculation is performed for comparison. This paper reports the preliminary results of this study.

Favourable effect of statin therapy on early survival benefit at the time of percutaneous coronary intervention for ST-elevation myocardial infarction and shock.

AIMS: Long-term administration of statin therapy has been shown to reduce major coronary events and cardiac mortality within randomised clinical trials. Statins favourably affect platelet adhesion, thrombosis, endothelial function, inflammation, plaque stability, and ventricular arrhythmia, which may potentially improve outcome after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) and shock. Therefore, we hypothesised that statin therapy has an early beneficial effect among patients undergoing PCI for STEMI complicated by cardiogenic shock. METHODS AND RESULTS: We retrospectively collected data of consecutive patients undergoing emergency PCI for STEMI complicated by cardiogenic shock between January 2000 and June 2008. Baseline, procedural, and in-hospital data of statin-treated and non-statin-treated patients were compared. Propensity score and multivariate survival analysis were used to adjust for heterogeneity between the two groups. Of 111 patients who comprised the study population, 30/111 (27%) were treated with statin at the time of the procedure. Statin therapy was associated with an in-hospital mortality reduction (46.7% versus 70.4%; odds ratio, 0.32; 95% CI, 0.11-0.89; P=0.029). After adjusting for the propensity to receive statin therapy before the procedure and other confounders, statin therapy remained an independent predictor for in-hospital survival after coronary intervention (odds ratio, 0.35; 95% CI, 0.15 to 0.88; P=0.026). CONCLUSIONS: In this study cohort, statin therapy among patients undergoing emergency PCI for STEMI and cardiogenic shock is associated with a significant mortality advantage at early follow-up.