The American journal of cardiology
-
Acute chest pain (CP), a leading symptom of persons presenting to emergency departments (EDs), may represent a life-threatening emergency or nonurgent condition requiring routine outpatient follow-up. In either case, rapid provision of an electrocardiogram and clinician evaluation are essential for determining appropriate treatment or discharge from the ED. Data from the National Hospital Ambulatory Medical Care Survey were used to estimate the proportion of hospital ED visits for a chief symptom of CP in adults aged >or=25 years with documentation of both an electrocardiogram and mean and/or median wait time to see a clinician in the ED. ⋯ Median wait times for a physician were 12 minutes for those with ischemic CP, 15 minutes for those with other cardiac CP, 18 minutes for those with undifferentiated CP, and 25 minutes for those with noncardiac CP. From 1993 to 2004, ED visits for CP increased for younger (25 to 64 years) adults (1993: 15.6 per 1,000 population, 2.5 million visits vs 2004: 20.9 per 1,000, 4.0 million) and decreased for older adults (>or=65 years) (1993: 9.7 per 1,000; 1.5 million vs 2004: 7.3 per 1,000; 1.3 million). In conclusion, most ED patient visits for undifferentiated and cardiac CP included an electrocardiogram and timely clinician evaluation.
-
The level of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a strong predictor of mortality in patients with acute coronary syndrome and may be a strong prognostic marker in patients with chronic coronary artery disease. We investigated whether NT-pro-BNP could predict in-stent restenosis (ISR) in asymptomatic patients with preserved left ventricular (LV) systolic function who underwent percutaneous coronary intervention. We measured serum NT-pro-BNP levels in 249 patients (61 +/- 9 years of age; 73% men) with preserved LV systolic function (ejection fraction >50%) who underwent follow-up coronary angiography. ⋯ At the standard cutoff of >200 pg/ml, a high NT-pro-BNP level indicated a high probability of ISR (odds ratio 2.18, 95% confidence interval 1.0 to 4.5, p = 0.038). In multivariate analysis, NT-pro-BNP level was an independent predictor for ISR. In conclusion, NT-pro-BNP could be a predictor of ISR in asymptomatic patients with preserved LV systolic function.
-
Two cases of severe pulmonary arterial hypertension in patients with neurofibromatosis are reported. The published research is reviewed. In conclusion, it is suggested that the association between these conditions be recognized in the classification of pulmonary hypertension.
-
Studies of patients with acute myocardial infarction (MI) suggest that anterior transmural infarcts are associated with greater left ventricular (LV) remodeling compared with nontransmural nonanterior infarctions. It is unclear whether this relation also exists in long-term survivors of MI. Cardiac magnetic resonance imaging was used to explore the relation between myocardial scar size, localization, transmurality, and degree of long-term LV remodeling in patients with healed MI. ⋯ In multivariate analysis, scar size was the strongest independent predictor of ejection fraction and LV volumes independently of scar localization and transmurality. In conclusion, in the studied cohort, there was a linear relation between scar size and ejection fraction and LV volumes. This relation was independent of scar location and transmurality.
-
N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and blood urea nitrogen (BUN) predict outcomes in patients with heart failure (HF). However, it is unknown whether NT-pro-BNP is a better prognostic marker than BUN in patients hospitalized with HF. Chart reviews were performed on 257 consecutively hospitalized patients with HF whose NT-pro-BNP levels were drawn at the time of admission. ⋯ In conclusion, in patients admitted to hospitals with HF, BUN is at least an equal prognosticator of HF rehospitalization or death as NT-pro-BNP. BUN outperforms NT-pro-BNP in predicting mortality in patients with advanced HF. If admitting physicians are confident that the diagnosis of HF is correct, then admission NT-pro-BNP adds little to clinical management.