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Liu L, Karatasakis A, Kudenchuk PJ, Kirkpatrick JN, Sayre MR, Carlbom DJ, Johnson NJ, Probstfield JL, Counts C, Branch KRH. Scoping review of echocardiographic parameters associated with diagnosis and prognosis after resuscitated sudden cardiac arrest. Resuscitation 2023; 184:109719. [PMID: 36736949 DOI: 10.1016/j.resuscitation.2023.109719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
AIM Current international guidelines recommend early echocardiography after resuscitated sudden death despite limited data. Our aim was to analyze published data on early post-resuscitation echocardiography to identify cardiac causes of sudden death and prognostic implications. METHODS We reviewed MEDLINE, EMBASE, and CENTRAL databases to December 2021 for echocardiographic studies of adult patients after resuscitation from non-traumatic sudden death. Studies were included if echocardiography was performed <48 hours after resuscitation and reported (1) diagnostic accuracy to detect cardiac etiologies of sudden death or (2) prognostic outcomes. Diagnostic endpoints were associations of regional wall motion abnormalities (RWMA), ventricular function, and structural abnormalities with cardiac etiologies of arrest. Prognostic endpoints were associations of echocardiographic findings with survival to hospital discharge and favorable neurological outcome. RESULTS Of 2877 articles screened, 16 (0.6%) studies met inclusion criteria, comprising 2035 patients. Two of six studies formally reported diagnostic accuracy for echocardiography identifying cardiac etiology of arrest; RWMA (in 5 of 6 studies) were associated with presumed cardiac ischemia in 17-89% of cases. Among 12 prognostic studies, there was no association of reduced left ventricular ejection fraction with hospital survival (v10) or favorable neurologic status (n = 5). Echocardiographic high mitral E/e' ratio (n = 1) and right ventricular systolic dysfunction (n = 2) were associated with poor survival. CONCLUSION This scoping review highlights the limited data on early echocardiography in providing etiology of arrest and prognostic information after resuscitated sudden death. Further research is needed to refine the clinical application of early echocardiographic findings in post arrest care.
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Affiliation(s)
- Linda Liu
- University of Washington, Department of Medicine, Seattle, WA, United States.
| | - Aris Karatasakis
- University of Washington, Division of Cardiology, Seattle, WA, United States.
| | - Peter J Kudenchuk
- University of Washington, Division of Cardiology, Seattle, WA, United States.
| | - James N Kirkpatrick
- University of Washington, Division of Cardiology, Seattle, WA, United States.
| | - Michael R Sayre
- University of Washington, Department of Emergency Medicine, Seattle, WA, United States.
| | - David J Carlbom
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, United States.
| | - Nicholas J Johnson
- University of Washington, Department of Emergency Medicine, Seattle, WA, United States; University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, United States.
| | | | - Catherine Counts
- University of Washington, Department of Emergency Medicine, Seattle, WA, United States.
| | - Kelley R H Branch
- University of Washington, Division of Cardiology, Seattle, WA, United States.
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Ebuchi Y, Nagaoka T, Fukamachi D, Kojima K, Akutsu N, Murata N, Saito Y, Kitano D, Yokota H, Yamagami S, Okumura Y. Comprehensive assessment of systemic arteriosclerosis in relation to the ocular resistive index in acute coronary syndrome patients. Sci Rep 2022; 12:2321. [PMID: 35149710 PMCID: PMC8837772 DOI: 10.1038/s41598-021-04196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the relationship between ocular vascular resistance parameters, evaluated by laser speckle flowgraphy (LSFG), and systemic atherosclerosis, renal parameters and cardiac function in acute coronary syndrome (ACS) patients. We evaluated 53 ACS patients between April 2019 and September 2020. LSFG measured the mean blur rate (MBR) and ocular blowout time (BOT) and resistivity index (RI). 110 consequent patients without a history of coronary artery disease who visited ophthalmology as a control group. Significant positive correlations were observed between ocular RI and systemic parameters in ACS patients, including intima-media thickness (r = 0.34, P = 0.015), brachial-ankle pulse-wave velocity (r = 0.41, P = 0.002), cystatin C (r = 0.32, P = 0.020), and E/e’ (r = 0.34, P = 0.013). Ocular RI was significantly higher in the ACS group than in the control group in male in their 40 s (0.37 ± 0.02 vs. 0.29 ± 0.01, P < 0.001) and 50 s (0.36 ± 0.02 vs. 0.30 ± 0.01, P = 0.01). We found that the ocular RI was associated with systemic atherosclerosis, early renal dysfunction, and diastolic cardiac dysfunction in ACS patients, suggesting that it could be a useful non-invasive comprehensive arteriosclerotic marker.
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Affiliation(s)
- Yasunari Ebuchi
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Taiji Nagaoka
- Division of Ophthalmology, Nihon University Itabashi Hospital, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Daisuke Fukamachi
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Keisuke Kojima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Naotaka Akutsu
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yuki Saito
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Daisuke Kitano
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Harumasa Yokota
- Division of Ophthalmology, Nihon University Itabashi Hospital, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoru Yamagami
- Division of Ophthalmology, Nihon University Itabashi Hospital, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
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Oh S, Kim JH, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH. Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease. Medicine (Baltimore) 2022; 101:e28627. [PMID: 35060541 PMCID: PMC8772642 DOI: 10.1097/md.0000000000028627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/02/2022] [Indexed: 01/05/2023] Open
Abstract
Acute myocardial infarction (AMI) and chronic obstructive pulmonary disease (COPD) are leading global causes of morbidity and mortality. In patients with both of these conditions, the presence of pulmonary hypertension (PH) can further worsen their prognosis. We examined the outcomes of AMI patients with COPD (AMI+COPD) and without COPD (AMI-COPD), depending on the presence or absence of PH.A total of 318 AMI patients with COPD (AMI+COPD cohort) (n = 109) or without COPD (AMI-COPD cohort) (n = 209) were included in this study and were subdivided into 2 groups according to right ventricular systolic pressure (RVSP) level (PH group [RVSP ≥35 mm Hg] and no PH group [RVSP <35 mm Hg]).We investigated characteristics and clinical outcomes in both the AMI-COPD and AMI+COPD cohorts. When investigating in-hospital clinical outcomes, the PH group had a higher proportion of new-onset heart failure (HF) in both cohorts. In the AMI+COPD cohort, however, the PH group had a higher incidence of cardiogenic shock than the no PH group, which was consistent with the result of the post-inverse probability of treatment weighting (IPTW) analysis. When investigating 1-year clinical outcomes, the PH group had higher incidences of a major adverse cardiac event and all-cause mortality in both cohorts. This finding was mainly driven by cardiac death in the AMI-COPD cohort, whereas it was mainly driven by non-cardiac death in the AMI+COPD cohort. After IPTW adjustment, these differences were statistically attenuated such that all variables were similar between both groups.PH may be associated with the development of new-onset HF (in all patients) and cardiogenic shock (in the AMI+COPD cohort). In addition, PH may be also associated with all-cause mortality, although it was statistically attenuated after IPTW adjustment.
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Gudnadottir GS, Gudnason T, Wilhelmson K, Ravn-Fischer A. Multimorbidity and Readmissions in Older People with Acute Coronary Syndromes. Cardiology 2022; 147:121-132. [PMID: 35042214 PMCID: PMC9153360 DOI: 10.1159/000522016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022]
Abstract
AIMS This study aimed to examine the multimorbidity as well as the 30-day and 1-year readmission rates in a large, unselected cohort of elderly patients with acute coronary syndrome (ACS). METHODS AND RESULTS All patients ≥70 years hospitalized due to ACS during January 1, 2006, to December 31, 2013, and registered in the SWEDEHEART registry were included. In-hospital multimorbidity and disease burden were determined. Outcomes included 30-day and 1-year all-cause mortality, any readmission, and readmissions due to ACS, heart failure, ischaemic stroke or transient ischaemic attack (TIA), and bleeding events. Out of 80,176 patients, 25.6% had ST-elevation myocardial infarction (STEMI) and 74.4% non-ST-segment elevation ACS (NSTE-ACS). The mean age was 79.8 (±6.4 standard deviation) and 43.4% were women. Multimorbidity, or two chronic diseases, was present in 67.7%, thereof in 53.0% of STEMI patients and 72.7% of NSTE-ACS patients. In-hospital mortality was 7.0%. Of the 74,577 patients who survived to discharge, 24.6% were readmitted within 30 days and 59.5% were readmitted during the following year. Multimorbid patients had a higher risk of readmissions than those without multimorbidity. Multimorbid STEMI patients were admitted the following year in 56.2% of cases compared to 44.5% of STEMI patients without multimorbidity, adjusted odds ratio (OR) 1.35 (95% confidence interval: 1.26-1.45). Multimorbid patients with NSTE-ACS were readmitted in 63.4% of cases the following year compared with 49.1% of those without multimorbidity, adjusted OR 1.42 (1.35-1.50). More than half of the readmissions were due to cardiovascular causes (ACS, stroke, TIA, or heart failure) or bleeding events. CONCLUSIONS Older people with ACS have a high multimorbidity burden and a high readmission rate both within 30 days and 1 year. Half of the readmissions were due to a cardiovascular event or a bleeding event. The presence of multimorbidity increases the risk of readmissions for patients with ACS. As hospital admissions are costly for the health care system and can include risks, especially for older patients, there may be opportunities in better risk stratifying this group at discharge for subsequent decrease in readmission rates.
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Affiliation(s)
- Gudny Stella Gudnadottir
- Department of Acute Medicine and Geriatrics, Section of Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Center for Aging and Health AgeCAP, University of Gothenburg, Gothenburg, Sweden
| | | | - Katarina Wilhelmson
- Department of Acute Medicine and Geriatrics, Section of Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Aging and Health AgeCAP, University of Gothenburg, Gothenburg, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg, Sweden
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Gudnadottir GS, James SK, Andersen K, Lagerqvist B, Thrainsdottir IS, Ravn-Fischer A, Varenhorst C, Gudnason T. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management. Am Heart J 2019; 211:11-21. [PMID: 30831330 DOI: 10.1016/j.ahj.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. METHODS We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidity and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography ≤14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. RESULTS We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). CONCLUSIONS Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.
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Azoz A, Youssef A, Alshehri A, Gad A, Rashed M, Yahia M, Alsharqi M, Al Saikhan L. Correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarction. J Electrocardiol 2018; 51:592-597. [PMID: 29996996 DOI: 10.1016/j.jelectrocard.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/01/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diastolic dysfunction is the early sign of myocardial ischemia that usually occurs earlier than ECG changes. AIM OF THE STUDY To determine the existence of a correlation between ST segment shift and diastolic dysfunction among patients with AMI. METHODS Fourty six patients with significant ST segment elevation or depression and having symptoms of acute myocardial infarction for <12 h were enrolled in this study. Patients were examined for serial ECG, cardiac enzymes, and echocardiography. RESULTS There was no significant correlation between ST segment elevation or depression and majority of the diastolic indices. Few diastolic parameters; such as, E/A ratio of the mitral valve and deceleration time of the tricuspid valve showed a direct correlation with the ECG changes. Whereas, the Tei Index of the LV function showed a borderline correlation to the ST segment elevation at discharge. CONCLUSION Overall, there was no correlation between either ST segment elevation or depression and the LV or RV diastolic function in patients with acute coronary syndrome (ACS). Improvement of the ST segment total score was associated with improvement of the diastolic function grades at discharge. Moreover, this association has shown an evidence of dose response relationship, the more improvement in total score at discharge the more improvement in diastolic function grade level.
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Affiliation(s)
- Ayman Azoz
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Adel Youssef
- Department of Health Information Management, College of Public Health, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdullah Alshehri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Ahmed Gad
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mostafa Rashed
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mohamed Yahia
- Department of Cardiology, Faculty of Medicine, University of Menoufia, Egypt
| | - Maryam Alsharqi
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Lamia Al Saikhan
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome. J Int Med Res 2017; 45:1680-1692. [PMID: 29239257 PMCID: PMC5805198 DOI: 10.1177/0300060517698265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chest pain is an important presenting symptom. However, few cases of chest pain
are diagnosed as acute coronary syndrome (ACS) in the acute setting. This
results in frequent inappropriate discharge and major delay in treatment for
patients with underlying ACS. The conventional methods of assessing ACS, which
include electrocardiography and serological markers of infarct, can take time to
manifest. Recent studies have investigated more sensitive and specific imaging
modalities that can be used. Diastolic dysfunction occurs early following
coronary artery occlusion and its detection is useful in confirming the
diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic
resonance provides a single imaging modality for comprehensive evaluation of
chest pain in the acute setting. In particular, cardiac magnetic resonance has
many imaging techniques that assess diastolic dysfunction post-coronary artery
occlusion. Techniques such as measurement of left atrial size, mitral inflow,
and mitral annular and pulmonary vein flow velocities with phase-contrast
imaging enable general assessment of ventricular diastolic function. More novel
imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and
myocardial tagging, allow early determination of regional diastolic dysfunction
and oedema. These findings may correspond to specific infarcted arteries that
may be used to tailor eventual percutaneous coronary artery intervention.
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Affiliation(s)
- Shah M. Azarisman
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
- Department of Internal Medicine,
International Islamic University Malaysia, Pahang, Malaysia
- Shah M Azarisman, Professor of Medicine,
International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar
InderaMahkota, 25200 Kuantan, Pahang, Malaysia.
| | - Karen S Teo
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
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Characterisation of Myocardial Injury via T1 Mapping in Early Reperfused Myocardial Infarction and its Relationship with Global and Regional Diastolic Dysfunction. Heart Lung Circ 2016; 25:1094-1106. [DOI: 10.1016/j.hlc.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/28/2016] [Indexed: 01/31/2023]
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Digital Health Intervention as an Adjunct to Cardiac Rehabilitation Reduces Cardiovascular Risk Factors and Rehospitalizations. J Cardiovasc Transl Res 2015; 8:283-92. [PMID: 25946990 DOI: 10.1007/s12265-015-9629-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/20/2015] [Indexed: 01/05/2023]
Abstract
Cardiac rehabilitation (CR) following myocardial infarction is vastly underused. As such, the aim of this study was to test a digital health intervention (DHI) as an adjunct to CR. Patients undergoing standard Mayo Clinic CR were recruited prior to CR (n = 25) or after 3 months CR (n = 17). Changes in risk factors and rehospitalizations plus emergency department (ED) visits were assessed after 3 months. Patients assigned to DHI during CR had significant reductions in weight (-4.0 ± 5.2 kg, P = .001), blood pressure (-10.8 ± 13.5 mmHg, P = .0009), and the group using DHI after 3 months of CR had significant reductions in weight (-2.5 ± 3.8 kg, P = .04) and systolic BP (-12.6 ± 12.4 mmHg, P = .001) compared to the control groups. Both DHI groups also displayed significant reductions in rehospitalizations/ED visits (-37.9 %, P = 0.01 and -28 %, P = .04, respectively). This study suggests that a guideline-driven DHI CR program can augment secondary prevention strategies during usual CR by improving risk factors for repeat events.
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Gharacholou SM, Scott CG, Takahashi PY, Nkomo VT, McCully RB, Fine NM, Pellikka PA. Left ventricular diastolic function and long-term outcomes in patients with normal exercise echocardiographic findings. Am J Cardiol 2013; 112:200-7. [PMID: 23611754 DOI: 10.1016/j.amjcard.2013.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Abstract
The objective of the present study was to determine whether diastolic dysfunction (DD) is associated with outcomes in the absence of myocardial ischemia. We studied 2,835 patients undergoing exercise echocardiography from January 2006 through December 2006 who had normal systolic function (ejection fraction ≥50%) and an absence of exercise-induced wall motion abnormalities. Diastolic function was graded as normal, mild DD, or moderate to severe DD. Medical records review and patient contact were undertaken to determine mortality, cardiovascular events (i.e., death, myocardial infarction, or stroke), incident heart failure (HF), and hospitalization. The mean ± SD age was 58.9 ± 12.8 years, and 54.0% were women. DD was present in 40.0% of the participants, with mild DD in 28.2% and moderate to severe DD in 11.8%. During a median follow-up of 4.4 years, 81 deaths and 114 cardiovascular events occurred, and DD was associated with greater rates of mortality, cardiovascular events, and HF events or hospitalizations (all p <0.001). On multivariate analysis, mild or moderate to severe DD (referent, normal function) was associated with HF or hospitalization (hazard ratio 1.45, 95% confidence interval 1.18 to 1.78, p <0.001 for mild DD; hazard ratio 1.75, 95% confidence interval 1.37 to 2.24, p <0.001 for moderate to severe DD) but was not independently associated with death or cardiovascular events. The diastolic index of filling pressure (E/e') was independently associated with mortality, cardiovascular events, and HF or hospitalization. In conclusion, among patients without demonstrable myocardial ischemia, left ventricular DD was associated with greater event rates during long-term follow up but did not independently predict hard end points other than HF or hospitalization. E/e' was independently associated with the clinical outcomes and might be an important echocardiographically derived parameter to identify in patients undergoing exercise echocardiography.
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Ephrem G. Red blood cell distribution width is a predictor of readmission in cardiac patients. Clin Cardiol 2013; 36:293-9. [PMID: 23553899 DOI: 10.1002/clc.22116] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 02/23/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Three-quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable. A screening tool for the detection of potential readmission may facilitate more efficient case management. HYPOTHESIS An elevated red blood cell distribution width (RDW) is an independent predictor of hospital readmission in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI). METHODS The study is a retrospective observational cohort analysis of adults admitted in 2007 with UA or NSTEMI. Data were gathered by review of inpatient medical records. The rate of 30-day nonelective readmission and time to nonelective readmission were recorded until November 1, 2011, and compared by RDW group using the 95th percentile (16.3%) as a cutoff. RESULTS The median follow-up time of the 503 subjects (average age, 65 ± 13 years; 56% male) was 3.8 years (interquartile range: 0.3-4.3 years). Those readmitted within 30 days were older, had more comorbidities and higher RDW and creatinine levels, and were more likely to have had an intervention. At 3.8 years of follow-up, subjects with high RDW (>16.3%) were more likely to be readmitted compared to those with normal RDW (≤16.3%) (72.28% vs 59.95%, P = 0.003). In multivariable analyses, high RDW was a statistically significant predictor of readmission in general (hazard ratio: 1.35 (95% confidence interval [CI]:1.02-1.79), P = 0.033) but not of 30-day rehospitalization (odds ratio: 1.34 (95% CI: 0.78-2.31), P = 0.292). Its area under the receiver operating characteristic curve was 0.54 (sensitivity 23% and specificity 85%). CONCLUSIONS An elevated RDW is an independent predictor of hospital readmission in patients with UA or NSTEMI.
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Affiliation(s)
- Georges Ephrem
- Department of Cardiovascular Disease, Hofstra-North Shore-LIJ Health System, Manhasset, New York 11030, USA.
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12
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Mourouzis I, Forini F, Pantos C, Iervasi G. Thyroid hormone and cardiac disease: from basic concepts to clinical application. J Thyroid Res 2011; 2011:958626. [PMID: 21765997 PMCID: PMC3134399 DOI: 10.4061/2011/958626] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/16/2011] [Accepted: 03/20/2011] [Indexed: 01/17/2023] Open
Abstract
Nature's models of regeneration provide substantial evidence that a natural healing process may exist in the heart. Analogies existing between the damaged myocardium and the developing heart strongly indicate that regulatory factors which drive embryonic heart development may also control aspects of heart regeneration. In this context, thyroid hormone (TH) which is critical in heart maturation during development appears to have a reparative role in adult life. Thus, changes in TH -thyroid hormone receptor (TR) homeostasis are shown to govern the return of the damaged myocardium to the fetal phenotype. Accordingly, thyroid hormone treatment preferentially rebuilds the injured myocardium by reactivating developmental gene programming. Clinical data provide further support to this experimental evidence and changes in TH levels and in particular a reduction of biologically active triiodothyronine (T3) in plasma after myocardial infarction or during evolution of heart failure, are strongly correlated with patients morbidity and mortality. The potential of TH to regenerate a diseased heart has now been testing in patients with acute myocardial infarction in a phase II, randomized, double blind, placebo-controlled study (the THiRST study).
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Diagnostic and therapeutic implications in post–myocardial infarct patients with raised brain natriuretic peptide levels. Am J Emerg Med 2011; 29:237-8; author reply 238. [DOI: 10.1016/j.ajem.2010.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022] Open
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15
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Chen YF, Redetzke RA, Said S, Beyer AJ, Gerdes AM. Changes in left ventricular function and remodeling after myocardial infarction in hypothyroid rats. Am J Physiol Heart Circ Physiol 2010; 298:H259-62. [DOI: 10.1152/ajpheart.00755.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has been shown that hypothyroidism may lead to delayed wound healing after experimental myocardial infarction (MI) in rats and increased infarct size in dogs. However, the long-term effect of hypothyroidism on left ventricular (LV) remodeling after MI has not been determined. Adult female Sprague-Dawley rats with and without surgical thyroidectomy (TX) were used in the study. Four weeks after TX, MI or sham MI was performed on TX and non-TX rats. Rats from all groups were examined 4 wk later. Four weeks after TX, hypothyroid-induced LV dysfunction was confirmed by echocardiography. In terminal experiments 4 wk after MI, TX sham-MI rats showed smaller hearts and impaired LV function compared with non-TX sham-MI controls. TX + MI rats showed smaller hearts with bigger infarct areas, higher LV end-diastolic pressures, and greater impairment of relaxation (−dP/d t) compared with non-TX MI rats. Relative changes after MI between TX and non-TX rats for most other hemodynamic and echocardiographic indexes were similar. These results suggest that preexisting hypothyroidism exaggerates post-MI remodeling and worsens LV function, particularly diastolic function.
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Affiliation(s)
- Yue-Feng Chen
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota
| | - Rebecca A. Redetzke
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota
| | - Suleman Said
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota
| | - April J. Beyer
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota
| | - A. Martin Gerdes
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota
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