Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 6 Articles
After treatment for myocardial infarction (MI) quite a few\npersons will experience different symptoms, including fatigue, during the recovery\nphase. The aim of the present study was to construct the multidimensional\nPost-Myocardial Infarction Fatigue (PMIF) scale, based on empirical\ndata gathered in coronary heart disease contexts. Methods: The construction\nof the post-MI fatigue scale was conducted in seven steps, ending in a psychometric\nevaluation of the internal structure of the scale, using confirmatory\nfactor analysis, as well as testing of convergent and discriminant validity, using\ncorrelational analysis, in a sample of 141 persons treated for MI. Results:\nThe results showed that the PMIF scale represents three dimensions: physical,\ncognitive and emotional fatigue. It was also found that the scale is suitable for\nsumming the items to obtain a total score representing a post-MI global fatigue\ndimension. Conclusion: The PMIF is a brief and easily completed scale\nfor identifying persons experiencing post-MI fatigue. Early identification of\nfatigue, together with health behavior support, might prevent progression\ntoward a more severe state of fatigue....
Background: Guidelines have classified patients with acute coronary syndrome (ACS) and diabetes as a special\npopulation, with specific sections presented for the management of these patients considering their extremely high\nrisk. However, in China up-to-date information is lacking regarding the burden of diabetes in patients with ACS and\nthe potential impact of diabetes status on the in-hospital outcomes of these patients. This study aims to provide\nupdated estimation for the burden of diabetes in patients with ACS in China and to evaluate whether diabetes is still\nassociated with excess risks of early mortality and major adverse cardiovascular and cerebrovascular events (MACCE)\nfor ACS patients.\nMethods: The Improving Care for Cardiovascular Disease in China-ACS Project was a collaborative study of the American\nHeart Association and the Chinese Society of Cardiology. A total of 63,450 inpatients with a definitive diagnosis\nof ACS were included. Prevalence of diabetes was evaluated in the overall study population and subgroups. Multivariate\nlogistic regression was performed to examine the association between diabetes and in-hospital outcomes, and a\npropensity-score-matched analysis was further conducted.\nResults: Among these ACS patients, 23,880 (37.6%) had diabetes/possible diabetes. Both STEMI and NSTE-ACS\npatients had a high prevalence of diabetes/possible diabetes (36.8% versus 39.0%). The prevalence of diabetes/possible\ndiabetes was higher in women (45.0% versus 35.2%, p < 0.001). Even in patients younger than 45 years, 26.9% had\ndiabetes/possible diabetes. While receiving comparable treatments for ACS, diabetes/possible diabetes was associated\nwith a twofold higher risk of all-cause death (adjusted odds ratio 2.04 [95% confidence interval 1.78â??2.33]) and a\n1.5-fold higher risk of MACCE (adjusted odds ratio 1.54 [95% confidence interval 1.39â??1.72]).\nConclusions: Diabetes was highly prevalent in patients with ACS in China. Considerable excess risks for early mortality\nand major adverse cardiovascular events were found in these patients....
Background: We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with\nsome modifications could be used to predict neurological outcomes in patients after extracorporeal\ncardiopulmonary resuscitation (ECPR).\nMethods: This was a retrospective, multicenter, observational study of adult unconscious patients who were evaluated\nby brain computed tomography (CT) within 48 hours after ECPR between May 2010 and December 2016. ASPECTS,\nbilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by ROC curves to predict neurological\noutcomes. The primary outcome was neurological status upon hospital discharge assessed with the Cerebral Performance\nCategories (CPC) scale.\nResults: Among 58 unconscious patients, survival to discharge was identified in 25 (43.1%) patients. Of these 25\nsurvivors, 19 (32.8%) had good neurological outcomes (CPC score of 1 or 2). Interrater reliability of CT scores was\nexcellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.918 (95% CI, 0.865â??0.950),\n0.918 (95% CI, 0.866â??0.951), and 0.915 (95% CI, 0.860â??0.949), respectively. The predictive performance of mASPECTS for\npoor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS, 0.922\nvs. 0.812, p = 0.004; mASPECTS vs. ASPECTS-b, 0.922 vs. 0.818, p = 0.003). A cutoff of 25 for poor neurological outcome\nhad a sensitivity of 84.6% (95% CI, 69.5â??94.1%) and a specificity of 89.5% (95% CI, 66.9â??98.7%) in mASPECTS.\nConclusions: mASPECTS might be useful for predicting neurological outcomes in patients after ECPR....
Objective. Numerous studies have investigated the prognostic role of frailty in elderly patients with heart failure (HF), but the\nlimited size of the reported studies has resulted in continued uncertainty regarding its prognostic impact. The aim of this study\nwas to integrate the findings of all available studies and estimate the impact of frailty on the prognosis of HF by performing a\nsystematic review and meta-analysis. Methods. PubMed, Embase, Cochrane, and Web of Science databases were searched from\ninception to November 8th 2017 to identify eligible prospective studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate\nstudy quality.The association between frailty and HF outcomes was reviewed. Overall hazard ratios (HRs) for the effects of frailty\non all-causemortality were pooled using a fixed-effect model and publication bias was evaluated using funnel plots. Results. A total\nof 10 studies involving 3033 elderly patients with HF were included in the systematic review and meta-analysis. All eligible studies\nindicated that frailty was of prognostic significance for HF patients.The HRs for the effects of frailty on all-cause mortality were\n1.70 (95% confidence interval (CI): 1.41â??2.04), based on the pooling of six studies that provided related data. However, publication\nbias was observed among the studies. Conclusions. Frailty has a high prevalence among older patients with HF. Elderly HF patients\nwith frailty have a poorer prognosis than those without frailty. Further studies are now required to implement the use of frailty\nassessment tools and explore effective interventions for frailty in older HF patients....
Background: In patients with left ventricular (LV) dysssynchrony, contraction that doesnâ??t fall into ejection period\n(LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by\ncardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient\nContraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac\ncycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome.\nMethods: Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing\nand contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated\naccordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization,\nand secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of\ntime to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes.\nResults: According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up,\nsubjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78â??0.97, P < 0.05)\nand maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36â??3.61, P < 0.01) were the two independent\npredictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer\nmyocardial contraction efficiency and better contractility are more likely to benefit from CRT.\nConclusions: STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response.\nWhen analyzing myocardial strain by STE, contraction during LVEj should be highlighted....
The authors conducted an analytical cross-sectional study over a period of 3\nmonths among hypertensive patients, in order to determine the frequency of\nthe erectile dysfunction (ED), and to identify the predictive factors. It included\ntreated hypertensive patients, presenting an ED, defined as the incapacity\nto obtain or maintain an erection sufficient for satisfactory sexual activity.\nOn 265 hypertensive patients, 172 (65%) presented an ED. The average\nage was 58.2 Â} 9.7 years. The associated cardiovascular risk factors were\noverweight/obesity in 99 cases (37.4%), sedentariness in 90 cases (34%), diabetes\nmellitus in 50 cases (19%), dyslipidemia in 12 cases (4.5%), and tobacco\naddiction in 6 cases (2.3%). Arterial hypertension (HTN), old of 6.7 Â} 5.8\nyears, was treated by bitherapy in 129 cases (48.7%), and tritherapy in 102\ncases (38.5%). The principal therapeutic classes used were ACE inhibitors/\nARBs in 213 cases (81%), calcium antagonists in 205 cases (78%), thiazides\nin 137 cases (52.1%), and beta-blockers in 82 cases (31%). ED, severe in\n124 cases (72%), and moderate in 48 cases (28%), consisted of a difficulty to\nmaintain the erection in 78 cases (45.3%), to obtain the erection in 30 cases\n(17.4%), and the two partners in 64 cases (37.2%). In multivariate analysis,\nonly the age, seniority of HTN, and the existence of diabetes mellitus were the\npredictive factors of ED. The early and effective assumption of responsibility\nof the AHT, as well as other cardiovascular risk factors whose diabetes, would\nmake it possible to reduce the frequency of it, thus improving quality of life of\nthe hypertensive patients....
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