Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Introduction: Functional integrity of the hypothalamic pituitary axis is disrupted\nduring severe infection or stress. The observed blunted response to\ncorticotropin was interpreted as impaired secretory reserve of the adrenal\nglands and was termed as relative adrenocortical insufficiency. Aim of the\nwork: To study the incidence of adrenal insufficiency in patients developed\ncardiogenic shock complicating ST segment elevation myocardial infarction.\nMaterials and methods: Prospective cohort study was done for 90 patients\nadmitted to Algalaa Hospital for whom basal cortisol and ACTH level were\nmeasured immediately before a standard-dose (250 micro g) ACTH stimulation\ntest (SST) and 60 minutes after SST�����...
Background: In patients with cardiac resynchronization therapy (CRT), atrial fibrillation (AF) is associated with an\nunfavorable outcome and may cause loss of biventricular pacing (BivP). An effective delivery of BivP of more than\n98% of all ventricular beats has been shown to be a major determinant of CRT-success.\nMethods: At a Swedish tertiary referral center, data was retrospectively obtained from patient registers, medical\nrecords and preoperative electrocardiograms. Data regarding AF and BivP during the first year of follow-up was\nassessed from CRT-device interrogations. No intra-cardiac electrograms were studied. Kaplan-Meier curves and Coxregression\nanalyses adjusted for age, etiology of heart failure, left ventricular ejection fraction, left bundle branch\nblock and NYHA class were performed to assess the impact of AF and BivP on the risk of death or heart\ntransplantation (HTx) at 10-years of follow-up.\nResults: Preoperative AF-history was found in 54% of the 379 included patients and was associated with, but did\nnot independently predict death or HTx. The one-year incidence of new device-detected AF was 22% but not\nassociated with poorer prognosis. At one-year, AF-history and BivP less than equal to 98%, was associated with a higher risk of death\nor HTx compared to patients without AF (HR 1.9, 95%CI 1.2-3.0, p = 0.005) whereas AF and BivP> 98% was not (HR\n1.4, 95%CI 0.9-2.3, p = 0.14).\nConclusions: In CRT-recipients, AF-history is common and associated with poor outcome. AF-history does not\nindependently predict mortality and is probably only a marker of a more severe underlying disease. BivP less than equal to 98%\nduring first-year of CRT-treatment independently predicts poor outcome thus further supporting the use of 98%\nthreshold of BivP, which should be attained to maximize the benefits of CRT....
Background : Percutaneous coronary intervention is now the best way of management\nof acute coronary syndrome (ACS). Contrast induced nephropathy is a\nserious complication and greatly dependent on several factors. It is still unclear\nwhether the vascular access migrates CIN risk. Objective : To study the impact\nof Radial Access (RA) compared with Femoral Access (FA) on developing contrast-\ninduced nephropathy (CIN) in patients undergoing invasive management\nof acute coronary syndrome (ACS). Methods : Sixty patients eligible for invasive\nmanagement of ACS at cardiology department (Menoufia University hospital\nand National Heart Institute) were randomized into two groups. Group I: included\n30 patients with femoral approach and Group II: included 30 patients\nwith radial approach. The occurrence of CIN estimated by KDIGO definition\n(absolute increase in serum creatinine (SCr) by greater than and equal to0.5 mg/dl within 48 hours; or\nincrease in SCr to greater than and equal to25% of baseline) was estimated in both groups. Results : Only\n9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI\nthrough FA without statistically significant difference between the two approaches.\nConclusion: CIN is considered a potential complication of percutaneous \ncoronary intervention (PCI). Our study did not show the preference of\nusing an approach over the other....
Background: Development of instruments capable of detecting early stage vascular disease has increased interest\nin employing arterial stiffness (e.g. pulse wave velocity (PWV), augmentation index (AIx)) and endothelial dysfunction\n(e.g. reactive hyperemia index (RHI)) to diagnose atherosclerotic disease before occurrence of a cardiovascular event.\nHowever, amongst the equipment designed for this purpose, there is insufficient information regarding each of these\nparameters to establish appropriate cutoffs to distinguish between healthy and unhealthy blood vessels. To address\nthese limitations, the study was designed to establish the upper arterial stiffness and endothelial function thresholds\nin a healthy population, by comparing the outputs from different instruments capable of measuring PWV, AIx and RHI.\nMethods: A systematic comparison of PWV, AIx and RHI was conducted to determine the inter-relationships between\nthese parameters of vascular functionality. Outputs were obtained non-invasively using three instruments, the VP-1000\n(VP), SphygmoCor (SC), and EndoPAT (EP), in 40 apparently healthy males and females.\nResults: Correlations were found between the brachial-ankle PWV and radial-ankle PWV (by VP and SC), and PWV (VP)\nwith AIx (SC). The interchangeability of these outputs was demonstrated by the Bland Altman test, making\nit feasible to extrapolate cut-offs for radial-ankle PWV and AIx equivalent to brachial-ankle PWV that signify\nhealthy vessels. In contrast, RHI showed no association with AIx, suggesting these endothelial and arterial\nparameters are functionally distinct.\nConclusions: It was concluded that it is possible to compare the vascular function outputs of different instruments\nand identify healthy from unhealthy vessels, even though the approaches for quantifying the underlying physiological\nprocesses may differ. In this way, non-invasive determination of arterial function could be a new paradigm for detecting\nexisting early stage asymptomatic atherosclerotic disease in individuals using techniques that are amenable to the\nclinical setting....
Background: A left ventricular aneurysm is a mechanical complication of a\nmyocardial infarction that frequently develops on the anterior and apical\nwall. Survival of 3 to 5 years is 27% and 12%, respectively. Our objective is to\nreport 3 cases of ventricular aneurysms in atypical locations and analyze the\nsurvival of these patients. Material and Methods: Three patients with suspicion\nof ventricular aneurysm after acute myocardial infarction who sought\nattention at our institution were included. All underwent transthoracic echocardiograms\n(TTE), cardiac magnetic resonance (CMR), nuclear cardiology (NC),\ncoronary angiotomography and cardiac catheterization to assess the location\nand characteristics of the aneurysms, left ventricular systolic function and the\nanatomical and functional condition of the coronary arteries. Results: The\nmean age of studied patients was ...................................
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