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cardiac risk stratification

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https://www.readbyqxmd.com/read/29153562/noncontrast-myocardial-t1-mapping-by-cardiac-magnetic-resonance-predicts-outcome-in-patients-with-aortic-stenosis
#1
Heesun Lee, Jun-Bean Park, Yeonyee E Yoon, Eun-Ah Park, Hyung-Kwan Kim, Whal Lee, Yong-Jin Kim, Goo-Yeong Cho, Dae-Won Sohn, Andreas Greiser, Seung-Pyo Lee
OBJECTIVES: The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS). BACKGROUND: Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown. METHODS: A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68...
November 10, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29153203/galectin-3-in-heart-failure-an-update-of-the-last-3%C3%A2-years
#2
REVIEW
Carolin Gehlken, Navin Suthahar, Wouter C Meijers, Rudolf A de Boer
Galectin-3 plays a role in tissue inflammation, repair, and fibrosis. This article specifically focuses on heart failure (HF), in which galectin-3 has been shown to be a useful biomarker in prognosis and risk stratification, especially in HF with preserved ejection fraction. Experimental research has shown that galectin-3 directly induces pathologic remodeling of the heart, and is therefore considered a culprit protein in the development of cardiac fibrosis in HF, with potentially relevant clinical implications...
January 2018: Heart Failure Clinics
https://www.readbyqxmd.com/read/29153198/n-terminal-b-type-natriuretic-peptide-in-heart-failure
#3
REVIEW
Arthur Mark Richards
Plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is a guideline-mandated biomarker in heart failure (HF). Used as an inclusion criterion for therapeutic trials, NT-proBNP enriches trial populations and is a valid surrogate endpoint. Its diagnostic performance is best validated in acute decompensated HF (ADHF). NT-proBNP offers prognostic information independent of standard clinical predictors and refines risk stratification. With the advent of combined angiotensin 2 type 1 receptor blockade and neprilysin inhibition (ARNI) NT-proBNP retains its relationship to cardiac status and is the marker of choice in assessment of possible ADHF and in serial monitoring of HF patients receiving ARNI treatment...
January 2018: Heart Failure Clinics
https://www.readbyqxmd.com/read/29150426/long-term-outcomes-in-patients-with-type-2-myocardial-infarction-and-myocardial-injury
#4
Andrew R Chapman, Anoop S V Shah, Kuan Ken Lee, Atul Anand, Oliver Francis, Philip Adamson, David A McAllister, Fiona Strachan, David E Newby, Nicholas L Mills
Background -Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury. Methods -We identified consecutive patients (n=2,122) with elevated cardiac troponin I concentrations (≥0.05 μg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the Universal Definition of Myocardial Infarction...
November 17, 2017: Circulation
https://www.readbyqxmd.com/read/29149953/myocardial-perfusion-scans-and-mortality-in-asymptomatic-patients-awaiting-renal-transplantation
#5
A Jauhal, S Harenberg, J J Crawford, I Bare, B Prasad, L Zahorski, G Ollenberger, V Trivedi, V Chopra, A Shoker, A Lavoie, P Dehghani
Cardiac risk assessment for asymptomatic patients awaiting renal transplantation is controversial. Patients awaiting renal transplantation in Southern Saskatchewan from 2005 to 2015 were retrospectively reviewed. Patients underwent cardiac risk stratification with stress myocardial perfusion scan. Baseline clinical characteristics, nuclear scan results, all-cause mortality, and cardiovascular events were analyzed. Abnormal scans were defined as studies with reversible defects, wall motion abnormalities, lung uptake, or transient ischemic dilation...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29148628/clinical-significance-of-st-depression-at-exercise-stress-testing-in-competitive-athletes-usefulness-of-coronary-ct-during-screening
#6
Fabio Sperandii, Emanuele Guerra, Eliana Tranchita, Carlo Minganti, Chiara Lanzillo, Antonia Nigro, Federico Quaranta, Attilio Parisi, Mauro DI Roma, Luciano Maresca, Federica Fagnani, Leonardo Calò
BACKGROUND: Congenital coronary anomalies (CCAs) and coronary artery disease (CAD) arouse intense scientific and clinical interest in sports medicine and sports cardiology medical communities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercise stress testing represent the first instrumental assessment to evaluate electrocardiographic changes during effort. Coronary computed tomography angiography (CCTA) is an advanced accurate noninvasive imaging modality for excluding CAD and abnormalities of origin and course of coronary vessels...
November 17, 2017: Journal of Sports Medicine and Physical Fitness
https://www.readbyqxmd.com/read/29146587/prognostic-stratification-of-patients-with-st-segment-elevation-myocardial-infarction-prospect-a-cardiac-magnetic-resonance-study
#7
Gianluca Pontone, Andrea I Guaricci, Daniele Andreini, Giovanni Ferro, Marco Guglielmo, Andrea Baggiano, Laura Fusini, Giuseppe Muscogiuri, Valentina Lorenzoni, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Maria Elisabetta Mancini, Patrizia Carità, Massimo Verdecchia, Silvia Pica, Fabio Fazzari, Nicola Cosentino, Giancarlo Marenzi, Mark G Rabbat, Piergiuseppe Agostoni, Antonio L Bartorelli, Mauro Pepi, Pier Giorgio Masci
BACKGROUND: Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. METHODS AND RESULTS: Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61...
November 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29143103/combined-assessment-of-left-ventricular-end-diastolic-pressure-and-ejection-fraction-by-left-ventriculography-predicts-long-term-outcomes-of-patients-with-st-segment-elevation-myocardial-infarction
#8
Daiga Saito, Rine Nakanishi, Ippei Watanabe, Takayuki Yabe, Ryo Okubo, Hideo Amano, Mikihito Toda, Takanori Ikeda
In patients with ST-segment elevation myocardial infarction (STEMI), it is unclear if combined assessment of left ventricular end-diastolic pressure (LVEDP) and left ventricular ejection fraction (LVEF) improves prediction of major adverse cardiac events (MACE). We analyzed data from 266 STEMI patients who underwent successful percutaneous coronary intervention and subsequent left ventriculography (LVG). Patients were divided into 4 groups, as follows: Group 1, LVEDP < 21 mmHg and LVEF ≥ 55%; Group 2, LVEDP < 21 mmHg and LVEF < 55%; Group 3, LVEDP ≥ 21 mmHg and LVEF ≥ 55%; and Group 4, LVEDP ≥ 21 mmHg and LVEF < 55%...
November 15, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/29142986/cardiac-autonomic-neuropathy-predicts-all-cause-and-cardiovascular-mortality-in-patients-with-end-stage-renal-failure-a%C3%A2-5-year-prospective-study
#9
Dimitrios Doulgerakis, Ioannis Moyssakis, Chris J Kapelios, Ioanna Eleftheriadou, Stamatia Chorepsima, Spyridon Michail, Nikolaos Tentolouris
Introduction: Chronic renal disease is associated with increased cardiovascular (CV) mortality. Cardiac autonomic neuropathy (CAN) is predictive of mortality for diseases that affect the autonomic nervous system. We prospectively evaluated the prognostic value of indexes of left ventricular (LV) function and CAN in all-cause and CV mortality of patients with end-stage renal failure (ESRF). Methods: A total of 133 patients with ESRF were recruited. LV function was evaluated by echocardiography, whereas cardiac autonomic function was assessed using the battery of the 4 standardized tests proposed by Ewing...
July 2017: KI Reports
https://www.readbyqxmd.com/read/29141844/architectural-t-wave-analysis-and-identification-of-on-therapy-breakthrough-arrhythmic-risk-in-type-1-and-type-2-long-qt-syndrome
#10
Alan Sugrue, Ram K Rohatgi, Peter A Noseworthy, Vaclav Kremen, J Martijn Bos, Bo Qiang, Yehu Sapir, Zachi I Attia, Christopher G Scott, Peter Brady, Samuel J Asirvatham, Paul A Friedman, Michael J Ackerman
BACKGROUND: Although the hallmark of long-QT syndrome (LQTS) is abnormal cardiac repolarization, there are varying degrees of phenotypic expression and arrhythmic risk. Our aim was to evaluate the performance of a morphological T-wave analysis program in defining breakthrough LQTS arrhythmic risk beyond the QTc value. METHODS AND RESULTS: We analyzed 407 genetically confirmed patients with LQT1 (n=246; 43% men) and LQT2 (n=161; 41% men) over the mean follow-up period of 6...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29138293/icare-acs-improving-care-processes-for-patients-with-suspected-acute-coronary-syndrome-a-study-of-cross-system-implementation-of-a-national-clinical-pathway
#11
Martin P Than, John W Pickering, Jeremy M Dryden, Sally J Lord, S Andrew Aitken, Sally J Aldous, Kate E Allan, Michael W Ardagh, John W N Bonning, Rosie Callender, Laura R E Chapman, Jonathan P Christiansen, Andre P J Cromhout, Louise Cullen, Joanne M Deely, Gerard P Devlin, Katherine A Ferrier, Christopher M Florkowski, Christopher M A Frampton, Peter M George, Gregory J Hamilton, Allan S Jaffe, Andrew J Kerr, G Luke Larkin, Richard M Makower, Timothy J E Matthews, William A Parsonage, W Frank Peacock, Bradley F Peckler, Nicholaas C van Pelt, Louise Poynton, A Mark Richards, Anthony G Scott, Mark B Simmonds, David Smyth, Oliver P Thomas, Andrew C Y To, Stephen A Du Toit, Richard W Troughton, Kim M Yates
BACKGROUND : Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals. METHODS : This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements...
November 14, 2017: Circulation
https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#12
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29135622/troponin-limit-of-detection-plus-cardiac-risk-stratification-scores-to-rule-out-acute-myocardial-infarction-and-30-day-major-adverse-cardiac-events-in-ed-patients
#13
Mitchell D Datlow, Kelly M Gray, Adriel Watts, Deborah B Diercks, Bryn E Mumma
When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0-3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#14
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29132702/neutrophil-lymphocyte-ratio-prognostic-impact-in-heart-surgery-early-outcomes-and-late-survival
#15
Shuli Silberman, Ulfat Abu-Yunis, Rachel Tauber, Linda Shavit, Tal Grenader, Daniel Fink, Daniel Bitran, Ofer Merin
BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is a recognized marker of inflammation associated with poor outcomes in various clinical situations. We analyzed the prognostic significance of preoperative elevated NLR in patients undergoing cardiac surgery. METHODS: We performed a retrospective review of 3,027 consecutive patients undergoing cardiac surgery. Receiver-operating-characteristic was used to determine the cutoff value for elevated NLR. Multivariate regression was used to determine the predictive value of preoperative NLR on clinical outcomes...
November 10, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29131282/prognostic-value-of-daytime-heart-rate-blood-pressure-their-products-and-quotients-in-chronic-heart-failure
#16
Anna Kowalczys, Michał Bohdan, Marcin Gruchała
BACKGROUND: Chronic heart failure (CHF) is an important epidemiological and therapeuthic issue with poor prognosis. The aim of the study was to estimate the prognostic value of daytime heart rate (HR), blood pressure (BP), their products and quotients in patients with CHF. METHODS: The study included 80 stable patients with CHF and reduced left ventricular ejection fraction (LVEF ≤ 35%). Physical examination, laboratory blood tests, electrocardiogram, chest X-ray, echocardiography, 6-minute walk test (6MWT), telemetry monitoring and BP measurements were performed in all participants...
November 13, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/29128570/outcomes-in-degenerative-mitral-regurgitation-current-state-of-the-art-and-future-directions
#17
REVIEW
Milind Y Desai, Francesco Grigioni, Marco Di Eusanio, Matteo Saccocci, Maurizio Taramasso, Francesco Maisano, Rakesh M Suri, A Marc Gillinov
Mitral regurgitation (MR) is the one of the most frequent valvular heart diseases in the developed world, often requiring surgical correction. Degenerative MR is the most common type of non-ischemic, organic MR in the western world. Since no medical treatment has been shown to be effective in preventing the consequences of volume overload in asymptomatic degenerative MR, risk stratification is essential. Currently, this is achieved using clinical and precisely quantified echocardiographic parameters, with newer technologies like cardiac magnetic resonance gaining increasing prominence...
November 8, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29127948/association-of-high-sensitivity-cardiac-troponin-i-concentration-with-cardiac-outcomes-in-patients-with-suspected-acute-coronary-syndrome
#18
Andrew R Chapman, Kuan Ken Lee, David A McAllister, Louise Cullen, Jaimi H Greenslade, William Parsonage, Andrew Worster, Peter A Kavsak, Stefan Blankenberg, Johannes Neumann, Nils A Söerensen, Dirk Westermann, Madelon M Buijs, Gerard J E Verdel, John W Pickering, Martin P Than, Raphael Twerenbold, Patrick Badertscher, Zaid Sabti, Christian Mueller, Atul Anand, Philip Adamson, Fiona E Strachan, Amy Ferry, Dennis Sandeman, Alasdair Gray, Richard Body, Brian Keevil, Edward Carlton, Kim Greaves, Frederick K Korley, Thomas S Metkus, Yader Sandoval, Fred S Apple, David E Newby, Anoop S V Shah, Nicholas L Mills
Importance: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain. Objective: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome. Data Sources: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017...
November 11, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29126769/cardiovascular-complications-in-head-neck-microvascular-flap-reconstruction-a-retrospective-risk-stratification-and-outcomes-assessment
#19
Naseem Ghazali, Steven Caldroney, Donita Dyalram, Joshua E Lubek
BACKGROUND: To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. METHODS: A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. RESULTS: Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6...
October 12, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#20
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
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