ABSTRACT
The concept of point-of-care, problem-oriented focus cardiac ultrasound examination (FoCUS) is increasingly applied in the settings of medical emergencies, including cardiac diseases. The European Association of Cardiovascular Imaging (EACVI) recognizes that cardiologists are not the only medical professionals dealing with cardiovascular emergencies. In reality, emergency cardiac diagnostics and treatment are also carried out by a wide range of specialists. For the benefit of the patients, the EACVI encourages any medical professional, sufficiently trained to obtain valuable information from FoCUS, to use it in emergency settings. These medical professionals need to have the necessary knowledge to understand the obtained information entirely, and to use it correctly, thoughtfully and with care. In this document, the EACVI underlines major differences between echocardiography and FoCUS, and underscores the need for specific education and training in order to fully utilize advantages and minimize drawbacks of this type of cardiac ultrasound examination in the critically ill patients.
Subject(s)
Cardiology/standards , Critical Illness , Echocardiography/standards , Emergencies , Heart Diseases/diagnostic imaging , Point-of-Care Systems , Cardiology/education , HumansABSTRACT
AIMS: Previous studies indicate that diabetic patients show evidence of coexisting systolic and diastolic myocardial dysfunction when examined by new echocardiographic techniques. Yet, there is no systematic investigation of the serial age-related changes of left ventricular anatomy and function in this patient population. METHODS AND RESULTS: One hundred and sixty type 2 diabetic patients and 110 non-diabetic controls, all with no evidence of heart disease, were studied. The participants were stratified into four distinct age-groups (A: <46, B: 46-60, C: 61-75, and D: >75 years) and underwent full echocardiographic examination. Conventional systolic and diastolic parameters were similar between the study groups. However, tissue Doppler imaging examination revealed an impaired systolic and diastolic longitudinal myocardial function in diabetic patients vs. controls, although these differences were not noticed within the youngest age-group. Diastolic dysfunction was established concomitantly in both diabetic and control subjects in age-group B. In contrast, diabetic patients showed an earlier induction of myocardial systolic dysfunction, evidenced by significantly lower average systolic longitudinal myocardial velocity in age-group B. Independent predictors of systolic myocardial dysfunction were age, glycated haemoglobin, and systemic blood pressure. CONCLUSION: Type 2 diabetic patients demonstrate an early and concomitant induction of systolic and diastolic myocardial dysfunction as a preclinical manifestation of diabetic cardiomyopathy.
Subject(s)
Aging/physiology , Cardiomyopathies/diagnostic imaging , Diabetes Mellitus, Type 2/physiopathology , Heart Ventricles/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Aged , Analysis of Variance , Case-Control Studies , Chi-Square Distribution , Echocardiography, Doppler , Electrocardiography , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Systole/physiologyABSTRACT
The paradoxical hemodynamic response after surgical or catheter pericardial drainage for cardiac tamponade is an infrequent complication. This case report describes this occasional ominous consequence of surgical pericardial decompression and suggests possible physiological explanations of rapidly progressive heart failure and death.
Subject(s)
Cardiac Output, Low/physiopathology , Cardiac Tamponade/surgery , Myocardial Contraction/physiology , Pericardial Window Techniques/adverse effects , Aged , Cardiac Output, Low/diagnostic imaging , Cardiac Output, Low/etiology , Diastole , Echocardiography, Doppler , Fatal Outcome , Female , Humans , Postoperative Complications , Xiphoid BoneABSTRACT
RATIONALE: Phosphodiesterase type 5 (PDE5) inhibition has been proposed for the treatment for pulmonary arterial hypertension (PAH). OBJECTIVE: This study compared adding sildenafil, a PDE5 inhibitor, to conventional treatment with the current practice of adding bosentan, an endothelin receptor antagonist. METHODS: Twenty-six patients with PAH, idiopathic or associated with connective tissue disease, World Health Organization (WHO) functional class III, were randomized in a double-blind fashion to receive sildenafil (50 mg twice daily for 4 weeks, then 50 mg three times daily) or bosentan (62.5 mg twice daily for 4 weeks, then 125 mg twice daily) over 16 weeks. MEASUREMENTS: Changes in right ventricular (RV) mass (using cardiovascular magnetic resonance), 6-minute walk distance, cardiac function, brain natriuretic peptide, and Borg dyspnea index. MAIN RESULTS: When analyzed by intention to treat, there were no significant differences between the two treatment groups. One patient on sildenafil died suddenly. Patients on sildenafil who completed the protocol showed significant changes from baseline, namely, reductions in RV mass (-8.8 g; 95% confidence interval [CI], -2, -16; n = 13, p = 0.015) and plasma brain natriuretic peptide levels (-19.4 fmol x ml(-1); 95% CI, -5, -34; p = 0.014) and improvements in 6-minute walk distance (114 m; 95% CI, 67, 160; p = 0.0002), cardiac index (0.3 L x min(-1) x m(-2); 95% CI, 0.1, 0.4; p = 0.008), and systolic left ventricular eccentricity index (-0.2; 95% CI, -0.02, -0.37; p = 0.031). Bosentan improved 6-minute walk distance (59 m; 95% CI, 29, 89; n = 12, p = 0.001) and cardiac index (0.3; 95% CI, 0.1, 0.4; p = 0.008). CONCLUSIONS: Sildenafil added to conventional treatment reduces RV mass and improves cardiac function and exercise capacity in patients with PAH, WHO functional class III. Safety monitoring is important until more experience is obtained.
Subject(s)
Antihypertensive Agents/therapeutic use , Endothelin Receptor Antagonists , Hypertension, Pulmonary/drug therapy , Phosphodiesterase Inhibitors/therapeutic use , Piperazines/therapeutic use , Sulfonamides/therapeutic use , Adult , Bosentan , Double-Blind Method , Exercise Tolerance/drug effects , Female , Heart Ventricles/pathology , Humans , Hypertension, Pulmonary/blood , Hypertension, Pulmonary/pathology , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Organ Size/drug effects , Purines , Quality of Life , Sildenafil Citrate , Sulfones , Treatment OutcomeSubject(s)
Angina, Unstable/physiopathology , Diabetes Mellitus, Type 2/physiopathology , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Ventricular Function, Left/physiology , Aged , Analysis of Variance , Angina, Unstable/blood , Angina, Unstable/drug therapy , Blood Glucose/analysis , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Echocardiography, Doppler, Color/methods , Electrocardiography , Female , Humans , Infusions, Intravenous , Male , Treatment Outcome , Ventricular Function, Left/drug effectsABSTRACT
BACKGROUND: High plasma C-reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated. HYPOTHESIS: The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD). METHODS: In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow-up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%. RESULTS: By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3-3.6; p value = 0.02 in patients with CRP = 0.5-2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8-9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl. CONCLUSION: Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.
Subject(s)
C-Reactive Protein/analysis , Coronary Disease/blood , Aged , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Disease Progression , Female , Humans , Male , Middle Aged , Multivariate Analysis , Risk Assessment , Risk FactorsSubject(s)
Angina, Unstable/blood , Angina, Unstable/diagnosis , C-Reactive Protein/analysis , Electrocardiography, Ambulatory/methods , Aged , Analysis of Variance , Biomarkers/blood , Blood Chemical Analysis , Cohort Studies , Female , Humans , Logistic Models , Male , Middle Aged , Monitoring, Physiologic/methods , Multivariate Analysis , Myocardial Infarction/blood , Myocardial Infarction/diagnosis , Predictive Value of Tests , Probability , Prognosis , Prospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Statistics, NonparametricABSTRACT
BACKGROUND: Several studies have shown the independent association of high plasma C-reactive protein (CRP) levels with an adverse prognosis in patients with acute myocardial infarction. However, the possible association of plasma CRP levels with response to thrombolysis and short- and long-term cardiac mortality has not been investigated. The aim of this study was to evaluate these possible associations. METHODS: Three hundred nineteen consecutive patients who received intravenous thrombolysis because of ST-segment elevation acute myocardial infarction were prospectively studied. Patients were classified according to tertiles of plasma CRP levels on admission. RESULTS: Patients at the top tertile had a significantly lower incidence of complete ST-segment resolution (third vs first, P <.001, third vs second, P =.009) or Thrombolysis In Myocardial Infarction (TIMI) 3 flow in the infraction-related artery (third vs first, P <.001, third vs second, P =.02), more compromised left ventricular function (third vs first, P =.02, second vs third, P =.04), greater inhospital mortality (third vs first, P =.03, third vs second, P =.06), and greater 3-year cardiac mortality (third vs first, P =.01, third vs second, P =.07). CONCLUSIONS: Plasma levels of CRP on admission may be a predictor of reperfusion failure and of short- and long-term prognosis in patients with ST-segment elevation acute myocardial infarction.
Subject(s)
C-Reactive Protein/analysis , Myocardial Infarction/blood , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Analysis of Variance , Biomarkers/blood , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Prospective Studies , Survival Analysis , Treatment FailureABSTRACT
OBJECTIVES: This study tested the impact of intensive metabolic treatment with insulin on transient myocardial ischaemia detected with continuous 12-lead ST-segment monitoring during non-ST segment elevation acute coronary syndromes in type 2 diabetic patients. METHODS AND RESULTS: The study included 57 type 2 diabetic patients with non-ST segment elevation acute coronary syndromes.Twenty-eight patients randomized to conventional treatment plus intensive insulin therapy (group A) and twenty-nine to conventional therapy only (group B). Group A patients received insulin by infusion for 48 hours according to a predefined protocol aiming to maintain normoglycaemia. Group B patients received standard coronary care unit treatment. The ST-segment monitoring was performed for 48 hours in the coronary care unit. The two groups were comparable in terms of medical history, clinical and biochemical data. Three patients from both groups were excluded from the analysis because there was objective evidence for evolution in persistent ST-segment elevation acute myocardial infarction. Six patients (24%) from group A vs. twelve from group B (46.2%) had evidence of transient ischaemia (p = 0.098). Group A patients showed significantly lower values in the mean number [group A vs. group B: 0.4 +/- 0.8 vs. 2 +/- 3.1, p < 0.01] and total duration of ST-episodes [group A vs. group B: 2.4 +/- 5.1 vs. 21.2 +/- 31 min, p < 0.01]. Multivariate analysis revealed that the mean plasma glucose during the study period was a powerful predictor of the presence (b:0.377,p < 0.01), the number (b:0.523,p < 0.001) and the total duration (b: 0.686, p < 0.001) of ST-episodes, respectively. CONCLUSIONS; Intensive insulin treatment considerably decreases the number and the total duration of ST-episodes in type 2 diabetic patients suffering from non-ST segment elevation acute coronary syndromes.
Subject(s)
Coronary Disease/complications , Coronary Disease/drug therapy , Critical Care , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Insulin/therapeutic use , Ischemic Attack, Transient/etiology , Ischemic Attack, Transient/prevention & control , Aged , Biomarkers/blood , Blood Glucose/metabolism , Coronary Disease/blood , Diabetes Mellitus, Type 2/blood , Electrocardiography , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Patient Admission , Predictive Value of Tests , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVES: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS). BACKGROUND: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited. METHODS: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion (