RESUMEN
AIMS: The aim of this study is to describe the relationship between ventricular mechanical dyssynchrony (VMD) and echocardiographic indices of cardiac remodelling. METHODS AND RESULTS: We evaluated 219 ambulatory patients with chronic systolic heart failure [left ventricular ejection fraction (LVEF)
Asunto(s)
Ecocardiografía/estadística & datos numéricos , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Medición de Riesgo/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Enfermedad Crónica , Femenino , Insuficiencia Cardíaca/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Prevalencia , Factores de Riesgo , Disfunción Ventricular Izquierda/prevención & controlRESUMEN
Transthoracic echocardiography (TTE) is often technically difficult on patients in intensive care units. Contrast echocardiography can improve left ventricular wall visualization and the assessment of regional and global left ventricular wall motion. Our study undertook to determine what proportion of nondiagnostic TTE studies on patients in intensive care units could be salvaged (i.e., converted to diagnostic studies) with contrast. Ninety-two patients with nondiagnostic TTEs had a repeat study after contrast. Using predefined criteria, 51% of studies were salvaged with contrast. Female gender emerged as the only factor associated with less likelihood of salvaging a study.
Asunto(s)
Medios de Contraste , Unidades de Cuidados Coronarios , Ecocardiografía Transesofágica/métodos , Aumento de la Imagen/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Ecocardiografía Transesofágica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Randomization is the "gold standard" design for clinical research trials, and is accepted as the best way to reduce bias. Although some controversy remains over this matter, we believe equipoise is the fundamental ethical requirement for conducting a randomized clinical trial. Despite much attention to the ethics of randomization, the moral psychology of this study design has not been explored. This paper analyzes the ethical tensions that arise from conducting these studies, and examines the moral psychology of this design from the perspectives of physician-investigators and patient-subjects. We conclude with a discussion of the practical implications of this analysis.