Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 580
Filtrar
1.
Heart Lung Circ ; 28(9): 1421-1426, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31010637

RESUMO

Echocardiography is a common and increasingly used noninvasive imaging tool in medicine. In this paper, we imagine the echocardiography laboratory of the future and consider the challenges we face currently, and may face in the future, and how these might be overcome; challenges such as training enough sonographers to meet the increasing demands of the ageing population living with chronic cardiovascular disease and the need for surveillance in other clinical scenarios. We consider the changing qualification framework and the requirements for accreditation and registration in Australia and New Zealand and the potential for migrant sonographers to meet some of the increasing demand. Advanced scopes of practice are likely to be a feature of the future workforce and we consider some of the ways these may evolve. Lastly, we consider how the evolving clinical landscape and technology may change the way echocardiography is delivered.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia/tendências , Recursos Humanos/tendências , Austrália , Doença Crônica , Humanos , Nova Zelândia
2.
Int J Cardiovasc Imaging ; 35(7): 1259-1263, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30850907

RESUMO

Previous studies have demonstrated the impact of appropriate use criteria (AUC) education and feedback interventions in reducing unnecessary ordering of transthoracic echocardiography (TTE) by trainees. To our knowledge, no study has evaluated the impact of the addition of price transparency to this education and feedback model on TTE utilization by resident physicians. We performed an education and feedback quality improvement initiative combining charge transparency data with information on AUC. We hypothesized that the initiative would reduce the number of complete TTE ordered and increase the number of limited TTE ordered, anticipating there would be substitution of limited for complete studies. Residents rotating on inpatient teaching cardiology ward teams received education on AUC for TTE, indications for limited TTE, and hospital charges for TTE. Feedback was provided on the quantity and charges for complete and limited TTE ordered by each team. We analyzed the effects of the intervention using a linear mixed effects regression model to adjust for potential confounders. The post-intervention weeks showed a reduction of 4.6 complete TTE orders per 100 patients from previous weekly baseline of 31.3 complete TTE orders per 100 patients (p value = 0.012). Charges for complete TTE decreased $122 from baseline of $980 per patient (p value = 0.040) on a per-week basis. Secondarily, there was no statistically significant change in limited TTE ordering during the intervention period. This initiative shows the feasibility of a house staff-driven charge transparency and education/feedback initiative that decreased medical residents' ordering of inpatient TTE.


Assuntos
Ecocardiografia/tendências , Educação Médica Continuada/tendências , Feedback Formativo , Custos Hospitalares/tendências , Pacientes Internados , Internato e Residência/tendências , Padrões de Prática Médica/tendências , Procedimentos Desnecessários/tendências , Atitude do Pessoal de Saúde , Redução de Custos , Análise Custo-Benefício , Ecocardiografia/economia , Educação Médica Continuada/economia , Estudos de Viabilidade , Custos de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência/economia , Padrões de Prática Médica/economia , Valor Preditivo dos Testes , Estudos Prospectivos , Melhoria de Qualidade/economia , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/economia , Indicadores de Qualidade em Assistência à Saúde/tendências , Procedimentos Desnecessários/economia
3.
Life Sci ; 222: 13-21, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811965

RESUMO

AIMS: Carotid baroreceptor stimulation (CBS) has potential protective effects on chronic heart failure (CHF). The aim of our study was to investigate the effects of CBS on more detailed aspects of ventricular remodelling and the underlying mechanisms in a CHF canine model. MAIN METHODS: Twenty-four beagles were randomised into Con (n = 8), CHF (n = 8), and CHF-CBS (n = 8) groups. The CHF and CHF-CBS groups underwent 6 weeks of rapid ventricular pacing (RVP) at 250 beats per minute to establish a CHF model. Concomitant CBS was delivered together with RVP in the CHF-CBS group. KEY FINDINGS: RVP for 6 weeks caused typical heart failure in the CHF group. CBS significantly reversed the decrease in the high-frequency heart rate variability component and increase in low-frequency/high-frequency ratio induced by RVP. CBS significantly reduced cardiac dilation, improved left ventricle ejection fraction, and inhibited the increase in natriuretic peptide mRNA expression of LV tissue. CBS alleviated collagen volume fraction and reduced protein expression of transforming growth factor ß1, matrix metallopeptidase 2, and matrix metallopeptidase 9, as well as decreased the percentage of TUNEL-positive nuclei and protein expression of Caspase-3 in LV tissue. The intracellular PKA signalling pathway and cardiac inflammation of LV tissue were upregulated in the CHF group, and markedly inhibited by CBS. SIGNIFICANCE: Our study found that CBS improved cardiac performance and reversed ventricular remodelling in CHF canines by rebalancing the autonomic nervous system; the suppression of the intracellular PKA signalling pathway and cardiac inflammation might underly the mechanisms.


Assuntos
Estimulação Cardíaca Artificial/tendências , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Pressorreceptores/fisiologia , Remodelação Ventricular/fisiologia , Animais , Estimulação Cardíaca Artificial/efeitos adversos , Cães , Ecocardiografia/tendências , Estimulação Elétrica/métodos , Eletrocardiografia/tendências , Insuficiência Cardíaca/fisiopatologia , Masculino
6.
Med Klin Intensivmed Notfmed ; 114(5): 434-438, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29632969

RESUMO

Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.


Assuntos
Medicina de Emergência , Padrões de Prática Médica , Choque Cardiogênico , Cuidados Críticos , Ecocardiografia/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Ultrassonografia/tendências
7.
Int J Cardiol ; 276: 191-197, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30527346

RESUMO

BACKGROUND: Post-systolic shortening (PSS) is a novel echocardiographic marker of myocardial dysfunction. Our objective was to assess the prognostic value of PSS in patients following acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). METHODS: A total of 428 patients hospitalized for ACS (mean age 64 ±â€¯12 years, male 73%) underwent speckle tracking echocardiography following treatment with PCI (median 2 days). The individual endpoints were heart failure (HF), myocardial infarction (MI) and all-cause death. We excluded known HF. Presence of PSS was defined as post-systolic displacement ≥20% of maximum strain in one cardiac cycle. The post-systolic index (PSI) was defined as (100 × [maximum-strain cardiac cycle - peak-systolic strain])/(maximum-strain cardiac cycle)]. RESULTS: During median follow-up of 3.7 years (IQR 0.3, 5.2), 155 patients (36%) experienced HF, 52 (12%) had MI and 87 (20%) died from all causes. Patients experiencing HF had more walls displaying PSS (3.2 vs. 1.9 walls) and higher PSI (22% vs. 12%) (P < 0.001 both). In Cox proportional hazards models adjusted for baseline characteristics, invasive and echocardiographic measurements, the risk of HF increased incrementally with increasing number of walls with PSS (HR 1.28 95%CI 1.12-1.46, P < 0.001 per 1 increase in walls with PSS). The PSI remained an independent predictor of HF after adjustment (HR 1.61 95%CI 1.21-2.12, P = 0.001 per 1% increase). In the same adjusted models, MI and all-cause death were not significantly associated with PSS. CONCLUSION: Presence of PSS provides novel and independent prognostic information regarding the risk of future HF in patients with ACS following PCI.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Sístole/fisiologia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Estudos de Coortes , Ecocardiografia/métodos , Ecocardiografia/tendências , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
8.
Int J Cardiol ; 277: 178-185, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30442376

RESUMO

BACKGROUND: Although exercise-induced cardiac hypertrophy has been intensively investigated, its development and regression dynamics have not been comprehensively described. In the current study, we aimed to characterize the effects of regular exercise training and detraining on left ventricular (LV) morphology and function. METHODS: Rats were divided into exercised (n = 12) and control (n = 12) groups. Exercised rats swam 200 min/day for 12 weeks. After completion of the training protocol, rats remained sedentary for 8 weeks (detraining period). Echocardiographic follow-up was performed regularly to obtain LV long- and short-axis recordings for speckle-tracking echocardiography analysis. Global longitudinal and circumferential strain and systolic strain rate were measured. LV pressure-volume analysis was performed using additional groups of rats to obtain haemodynamic data. RESULTS: Echocardiographic examinations showed the development of LV hypertrophy in the exercised group. These differences disappeared during the detraining period. Strain and strain rate values were all increased after the training period, whereas supernormal values rapidly reversed to the control level after training cessation. Load-independent haemodynamic indices, e.g., preload recruitable stroke work, confirmed the exercise-induced systolic improvement and complete regression after detraining. CONCLUSIONS AND TRANSLATIONAL ASPECT: Our results provide the first comprehensive data to describe the development and regression dynamics of morphological and functional aspects of physiological hypertrophy in detail. Speckle-tracking echocardiography has been proven to be feasible to follow-up changes induced by exercise training and detraining and might provide an early possibility to differentiate between physiological and pathological conditions.


Assuntos
Cardiomegalia Induzida por Exercícios/fisiologia , Ventrículos do Coração/diagnóstico por imagem , Condicionamento Físico Animal/efeitos adversos , Condicionamento Físico Animal/tendências , Função Ventricular Esquerda/fisiologia , Animais , Ecocardiografia/tendências , Ventrículos do Coração/fisiopatologia , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar , Remodelação Ventricular/fisiologia
9.
J Cardiothorac Vasc Anesth ; 33(3): 725-731, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30316640

RESUMO

OBJECTIVE: An association between central venous pressure and acute kidney injury (AKI) has been observed following cardiac surgery, but it is unknown whether this reflects intravascular volume status or impaired right ventricular (RV) myocardial performance. This study was performed to test the hypothesis that decreased RV peak longitudinal strain (PLSS), as measured by 2-dimensional speckle-tracking echocardiography, is associated with AKI following cardiac surgery. DESIGN: Retrospective observational cohort study. SETTING: Cardiovascular intensive care unit in a 576-bed referral hospital. PARTICIPANTS: Adult patients having undergone cardiac surgery in whom a transthoracic echocardiogram (TTE) was performed within 48 hours after chest closure. INTERVENTIONS: This was a retrospective study. Urine output and serum creatinine values were recorded at baseline and for 48 hours after surgery. Statistical analysis was performed to identify differences in baseline demographic and echo-derived values between patients with and without postoperative AKI criteria. MEASUREMENTS AND MAIN RESULTS: One hundred ninety-nine subjects had postprocessing of TTE performed. AKI was observed in 87% of patients (173 of 199). Age, body mass index, and preoperative serum creatinine were higher in the AKI group. The mean PLSS was -17.2% ± 4.3% versus -17.1% ± 3.7% in patients with AKI versus those without (p = 0.95). The calculated RV systolic pressure was elevated in the AKI group compared to the non-AKI group (38.9 ± 9.9 v 34.6 ± 7.9 mmHg, p = 0.02). CONCLUSION: In this cohort of cardiac surgery patients, speckle-tracking analysis of RV myocardial performance was feasible. Elevated RV systolic pressure associated with AKI, while speckle tracking-derived echocardiography measurements did not.


Assuntos
Lesão Renal Aguda/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/tendências , Ecocardiografia/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Lesão Renal Aguda/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Disfunção Ventricular Direita/fisiopatologia
10.
J Cardiothorac Vasc Anesth ; 33(4): 1014-1021, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30072270

RESUMO

OBJECTIVES: Two-dimensional speckle tracking echocardiography has advantages over tissue Doppler imaging during isovolumetric relaxation for predicting left-ventricular end-diastolic pressure in non-surgical patients. Considering the direct and indirect effects of general anesthesia on hemodynamics, we examined correlations between strain-based indices during isovolumetric relaxation and pulmonary capillary wedge pressure in anesthetized patients. Moreover, we determined applicable cut-off values for strain-based indices to predict pulmonary capillary wedge pressure ≥15 mmHg intraoperatively. DESIGN: Retrospective clinical study. SETTING: Single university hospital. PARTICIPANTS: Thirty adult patients with preserved ejection fraction undergoing coronary artery bypass grafting. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two-dimensional speckle tracking echocardiography was used to measure strain rate during isovolumetric relaxation (SRIVR) and to calculate the mitral early diastolic inflow (E) to SRIVR ratio (E/SRIVR). Tissue Doppler imaging was used to calculate the E to early diastolic velocity at the lateral mitral annulus ratio (lateral E/e'). SRIVR and E/SRIVR showed strong correlations with pulmonary capillary wedge pressure (r = 0.80 and 0.73, respectively; p < 0.001 and p < 0.001). Lateral E/e' correlated with pulmonary capillary wedge pressure (r = 0.42; p < 0.05). SRIVR predicted high pulmonary capillary wedge pressure better than lateral E/e' did (areas under the receiver operating characteristic curves, 0.94-vs. 0.47, respectively). SRIVR <0.2 s-1 had a sensitivity of 100% and a specificity of 81% for predicting pulmonary capillary wedge pressure ≥15 mmHg. CONCLUSIONS: SRIVR is superior to tissue Doppler indices for predicting pulmonary capillary wedge pressure intraoperatively in patients with coronary artery disease and preserved ejection fraction.


Assuntos
Ponte de Artéria Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia/tendências , Monitorização Intraoperatória/tendências , Pressão Propulsora Pulmonar/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Estudos Retrospectivos , Vasodilatação/fisiologia
12.
J Am Coll Cardiol ; 72(22): 2778-2788, 2018 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-30497564

RESUMO

Echocardiography is the mainstay in screening for pulmonary hypertension (PH). International guidelines suggest echocardiographic parameters for suspecting PH, but these may not apply to many adults with congenital heart disease (ACHD). PH is relatively common in ACHD patients and can significantly affect their exercise capacity, quality of life, and prognosis. Identification of patients who have developed PH and who may benefit from further investigations (including cardiac catheterization) and treatment is thus extremely important. A systematic review and survey of experts from the United Kingdom and Ireland were performed to assess current knowledge and practice on echocardiographic screening for PH in ACHD. This paper presents the findings of the review and expert statements on the optimal approaches when using echocardiography to assess ACHD patients for PH, with particular focus on major subgroups: patients with right ventricular outflow tract obstruction, patients with systemic right ventricles, patients with unrepaired univentricular circulation, and patients with tetralogy of Fallot with pulmonary atresia.


Assuntos
Ecocardiografia/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Programas de Rastreamento/métodos , Ecocardiografia/tendências , Cardiopatias Congênitas/epidemiologia , Humanos , Hipertensão Pulmonar/epidemiologia , Imagem Cinética por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/tendências , Programas de Rastreamento/tendências
13.
J Am Coll Cardiol ; 72(21): 2577-2587, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30466515

RESUMO

BACKGROUND: Myocardial fibrosis (MF) according to cardiac magnetic resonance (CMR) is a frequent finding in Chagas cardiomyopathy and has been associated with risk factors of poor outcome. OBJECTIVES: The goal of this study was to determine the prognostic value of MF in predicting combined hard events or all-cause mortality. METHODS: Patients with Chagas cardiomyopathy who had a previous CMR evaluation were included, and clinical follow-up was retrospectively obtained. The primary outcome was a combination of all-cause mortality, heart transplantation, antitachycardia pacing or appropriate shock from an implantable cardioverter-defibrillator, and aborted sudden cardiac death; the secondary outcome was all-cause mortality. RESULTS: A total of 130 patients were included; mean age was 53.6 ± 11.5 years, and 53.9% were female. The majority of patients reported no symptoms of heart failure or arrhythmia, but electrocardiographic and echocardiographic abnormalities were common. On CMR, left ventricular dilatation and dysfunction were frequent, and MF was found in 76.1%, with a mean mass of 15.2 ± 16.5 g. Over a median follow-up of 5.05 years, 58 (44.6%) patients reached the combined endpoint, and 45 (34.6%) patients died. MF was associated with the primary outcome as a continuous variable (adjusted hazard ratio: 1.031; 95% CI: 1.013 to 1.049; p = 0.001) and as a categorical variable (MF ≥12.3 g) (adjusted hazard ratio: 2.107; 95% CI: 1.111 to 3.994; p = 0.022), independently from the Rassi risk score. MF expressed as a continuous variable was also associated with all-cause mortality (adjusted hazard ratio: 1.028; 95% CI: 1.005 to 1.051; p = 0.017) independently from the Rassi risk score. CONCLUSIONS: MF is an independent predictor of adverse outcome in Chagas cardiomyopathy. Our data may support the use of CMR in better risk-stratifying this population and possibly guiding therapy.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/mortalidade , Miocárdio/patologia , Adulto , Idoso , Estudos de Coortes , Ecocardiografia/tendências , Feminino , Fibrose/diagnóstico por imagem , Fibrose/mortalidade , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
15.
Am J Cardiol ; 122(11): 1972-1976, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30318419

RESUMO

The arterial switch operation (ASO) in complete transposition of the great arteries (TGA) has increased long-term survival. Annual follow-up echocardiograms are recommended, but evidence-based guidelines do not exist. We sought to assess how often a patient with TGA after ASO who had no symptoms or change in physical exam underwent an intervention based solely on echocardiographic changes. We retrospectively reviewed all records from patients with TGA and a history of ASO followed at our institution between November 1983 and January 2015. Changes in echocardiograms resulting in hospital admission, significant medication change, interventional catheterization, or surgical procedure were identified through the surgical and cardiac catheterization laboratory databases and patient charts. These changes were referred to as an actionable change (AC). Interventions were defined as being driven by either clinical (change in physical exam, patient and/or parental concerns) or echocardiographic findings. A total of 1,792 echocardiograms from 149 patients were reviewed. Median number of echocardiograms per patient was 12 (1 to 34). Of the 1,792 echocardiograms, 20 (1.12%) were associated with AC. The most common intervention for an AC was cardiac catheterization (13 of 20, 65%). Most AC (15 of 20, 75%) occurred in the first decade after ASO. AC occurred in 83% (5 of 6) of those with a history of both ASO and arch repair. Annual echocardiograms in patients with TGA after ASO are rarely useful and are unnecessary. In conclusion, decreasing surveillance of asymptomatic patients to biennial follow-up echocardiograms in asymptomatic patients without physical examination changes is safe and would decrease medical expenses.


Assuntos
Transposição das Grandes Artérias/métodos , Ecocardiografia/tendências , Transposição dos Grandes Vasos/diagnóstico , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Período Pós-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transposição dos Grandes Vasos/cirurgia
16.
Mo Med ; 115(4): 354-360, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30228767

RESUMO

Cardiac imaging plays a key role in the accurate diagnosis of pediatric congenital heart disease (CHD). Echocardiography and catheter angiography are traditionally used to delineate cardiac anatomy. CT and MRI imaging offer a non-invasive way to image cardiovascular anatomy which can be used in conjunction with echocardiography for the diagnosis and treatment planning for CHD. These modalities can depict the morphology and relationship to surrounding structures better than echocardiography, especially in complex congenital defects.


Assuntos
Angiografia Coronária/tendências , Ecocardiografia/tendências , Cardiopatias Congênitas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/tendências , Tomografia Computadorizada por Raios X/tendências , Cateterismo Cardíaco , Criança , Relação Dose-Resposta à Radiação , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/anatomia & histologia , Humanos , Processamento de Imagem Assistida por Computador
17.
Medicine (Baltimore) ; 97(35): e12104, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170434

RESUMO

Pulmonary embolism (PE) is a devastating diagnosis which carries a high mortality risk. Echocardiography is often performed to risk stratify patients diagnosed with PE, and guide management strategies. Trends in the performance of echocardiography among patients with PE and its role in influencing outcomes is unknown.We analyzed the 2005 to 2014 National Inpatient Sample Database to identify patients with primary diagnosis of PE or secondary diagnosis of PE and ≥1 of the following diagnoses: syncope, thrombolysis, acute deep vein thrombosis, acute cardiorespiratory failure, and secondary pulmonary hypertension. Trends in the performance of echocardiography and in-hospital mortality were analyzed. The admissions were divided into 2 groups with echocardiography, and without echocardiography, and 1:2 propensity score matching (PSM) was performed for comparison. The primary end-point was in-hospital mortality. The secondary endpoints were length of stay and total hospitalization costs. Odd ratios (OR) with confidence intervals (CI) were reported.A total of 299,536 unweighted PE cases were studied. Performance of echocardiography among patients with PE patients increased from 3.5% to 5.6%, whereas in-hospital mortality decreased from 4.2% to 3.7% between years 2005 and 2014. Before matching, patients who received an echocardiogram were more likely to be younger, African American, admitted to a large, urban teaching institute, and had higher rates of concurrent acute deep vein thrombosis, and acute respiratory failure. Post-PSM, patients who received echocardiography during hospitalization had lower in-hospital mortality (odds ratio 0.75, 95% confidence intervals (CI) 0.68-0.83; P < 0.001), longer length of stay (median 6 days vs 5 days; P < .001) and higher mean hospitalization costs ($34,379 vs $27,803; P < .001) compared to those without echocardiography.Performance of echocardiography among patients with a PE is increasing and is associated with lower in-hospital mortality.


Assuntos
Ecocardiografia/tendências , Embolia Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Ecocardiografia/economia , Feminino , Custos de Cuidados de Saúde/tendências , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Embolia Pulmonar/economia , Estudos Retrospectivos , Adulto Jovem
18.
Int J Cardiol ; 273: 8-14, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30170918

RESUMO

AIMS: To describe the contemporary management by cardiologists of patients after an episode of myocardial infarction (MI). METHODS: The EYESHOT Post-MI was a prospective, observational, nationwide study aimed to evaluate the management of patients referring to cardiologists 1 to 3 years from the last MI event. RESULTS: Over a 3-month period, 1633 consecutive patients [median 22 (IQR 15-28) months from MI] were enrolled: 1028 (63.0%) at the second and 605 (37.0%) at the third year from MI. During the 12 months prior to enrolment, the majority of patients received a transthoracic echocardiogram (60% and 54%), followed by coronary angiography (24% and 16%, in the second and third year from MI groups, respectively). At the time of enrolment, the majority of patients were prescribed on statins (93%) and beta-blockers (82%), without significant differences between the 2 groups. A dual antiplatelet therapy (DAPT) was used more frequently among patients presenting during the second compared to the third year from MI (40% vs 24%; p < 0.0001). At multivariable analysis, the time interval from last MI (2 vs 3 years: OR 2.27; 95% CI 1.79-2.88; p < 0.0001) and a previous percutaneous coronary intervention with multiple stents (OR 3.46; 95% CI 2.19-5.47; p < 0.0001) resulted as the major independent predictors of DAPT persistence at the time of enrolment. CONCLUSIONS: This contemporary registry provides unique insights into the current management of post-MI patients and represents an opportunity to further improve the long-term treatment of this high-risk population.


Assuntos
Cardiologistas/tendências , Gerenciamento Clínico , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Encaminhamento e Consulta/tendências , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Estudos Transversais , Quimioterapia Combinada , Ecocardiografia/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Fatores de Tempo
19.
Int J Cardiol ; 272: 142-148, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30170919

RESUMO

Second generation cryoballoon (CB) has been shown to be effective for treatment of paroxysmal and persistent atrial fibrillation (AF). However, the fixed size of the non-compliant balloon may limit its use in patients with pulmonary vein (PV) abnormalities. In this study we investigated the acute success, procedural complications and long term outcome of CB based PV isolation (PVI) in patients with PV abnormality. A total of 238 patients [64.8 ±â€¯11.1 years; 91 paroxysmal (38.2%), 147 persistent AF (61.8%)] underwent PVI using the second generation CB without preprocedural imaging. In 43/238 (18.1%) patients PV abnormality (left common PV in 26, right middle PV in 20) was observed. All targeted veins including abnormal PVs were isolated (100%). Transient phrenic nerve palsy (PNP) occurred in one (2.3%) patient in the PV anomalous group and 6 (3.0%) in the control group (p = NS). There was no other adverse event including PV stenosis, atrio-esophageal fistula or cerebrovascular events related to the procedure. During mean follow-up of 11.8 ±â€¯5.4 month a total of 59 patients (24.7%) had atrial tachyarrhythmia (ATA) recurrence [27 (11.3%) had AT recurrence]. In the PV anomalous group, 20/43 (46.5%) patients had ATA recurrence compared to 39/195 (20%) in the control group (p < 0.001). AT recurrence was observed in 27 (11.3) patients [11 (25.5%) in the PV anomalous group and 16 (8.2%) in controls respectively, p = 0.003]. In patients with PV abnormality CB-based AF ablation results in a similar acute PVI rate but a higher ATA recurrence rate during follow up as compared to patients without PV abnormality.


Assuntos
Ablação por Cateter/tendências , Criocirurgia/tendências , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Reoperação/tendências , Idoso , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Ecocardiografia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA