RESUMO
To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15-85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.
Assuntos
Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Ruídos Cardíacos , Fonocardiografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angiografia Coronária , Doença da Artéria Coronariana/classificação , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/classificação , Estenose Coronária/economia , Estenose Coronária/fisiopatologia , Redução de Custos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fonocardiografia/economia , Fonocardiografia/instrumentação , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
In vivo assessment of ventricular function in rodents has largely been restricted to transthoracic echocardiography (TTE). However 1.5 T cardiac magnetic resonance (CMR) and transoesophageal echocardiography (TOE) have emerged as possible alternatives. Yet, to date, no study has systematically assessed these three imaging modalities in determining ejection fraction (EF) in rats. Twenty rats underwent imaging four weeks after surgically-induced myocardial infarction. CMR was performed on a 1.5 T scanner, TTE was conducted using a 9.2 MHz transducer and TOE was performed with a 10 MHz intracardiac echo catheter. Correlation between the three techniques for EF determination and analysis reproducibility was assessed. Moderate-strong correlation was observed between the three modalities; the greatest between CMR and TOE (intraclass correlation coefficient (ICC) = 0.89), followed by TOE and TTE (ICC = 0.70) and CMR and TTE (ICC = 0.63). Intra- and inter-observer variations were excellent with CMR (ICC = 0.99 and 0.98 respectively), very good with TTE (0.90 and 0.89) and TOE (0.87 and 0.84). Each modality is a viable option for evaluating ventricular function in rats, however the high image quality and excellent reproducibility of CMR offers distinct advantages even at 1.5 T with conventional coils and software.
Assuntos
Ecocardiografia Transesofagiana/veterinária , Ecocardiografia/veterinária , Ventrículos do Coração/patologia , Imageamento por Ressonância Magnética/veterinária , Função Ventricular , Animais , Ventrículos do Coração/diagnóstico por imagem , Masculino , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos TestesAssuntos
Cidades , Meio Ambiente , Saúde Pública , Meios de Transporte , Austrália , Automóveis/economia , Automóveis/história , Automóveis/legislação & jurisprudência , Cidades/economia , Cidades/história , Cidades/legislação & jurisprudência , História do Século XX , Habitação/economia , Habitação/história , Habitação/legislação & jurisprudência , Los Angeles , Densidade Demográfica , Saúde Pública/economia , Saúde Pública/história , Saúde Pública/legislação & jurisprudência , Saúde Suburbana/história , População Suburbana/história , Meios de Transporte/economia , Meios de Transporte/história , Meios de Transporte/legislação & jurisprudência , Saúde da População Urbana/história , População Urbana/históriaAssuntos
Produtos Agrícolas , Abastecimento de Alimentos , Tecnologia de Alimentos , Triticum , Agricultura/economia , Agricultura/história , Austrália/etnologia , Produtos Agrícolas/economia , Produtos Agrícolas/história , Características da Família/etnologia , Saúde da Família/etnologia , Fertilizantes/economia , Fertilizantes/história , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/história , Tecnologia de Alimentos/economia , Tecnologia de Alimentos/educação , Tecnologia de Alimentos/história , História do Século XIX , História do Século XX , Fatores Socioeconômicos , Tecnologia/economia , Tecnologia/educação , Tecnologia/história , Triticum/economia , Triticum/históriaRESUMO
In September 1997, Médecins Sans Frontières-Holland (MSF-H) began a project to provide training and support for HIV/AIDS prevention among injecting drug users (IDUs) in the Russian Federation, focusing on the use of the World Health Organization Rapid Assessment and Response Guide on Injecting Drug Use, and the European Peer Support Manual. As part of the training, participants are asked to carry out a rapid situation assessment (RSA) in their city or region as a major step towards designing and implementing an effective program to prevent HIV transmission among IDUs. This paper focuses on the first four training cycles of the programme (from January 1998 to January 1999), in which 89 health professionals and others from 32 Russian cities took part. A total of 28 rapid situation assessments were completed or almost completed by participants during these four cycles. The paper provides an overview of the methods used and major problems faced by participants undertaking these assessments, as well as summarising the 14 harm reduction programmes which resulted.