The American journal of cardiology
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It remains unknown whether left ventricular (LV) reverse remodeling (LVRR) after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and β blockers is correlated with prognosis in patients with idiopathic dilated cardiomyopathy. Forty-two patients with idiopathic dilated cardiomyopathy treated with the therapy were studied. Complete left ventricular reverse remodeling was defined as LV end-diastolic dimension ≤ 55 mm and fractional shortening ≥ 25% at the last echocardiographic assessment. ⋯ The decrease in LV end-systolic dimension from the initial value to that at 1 to 6 months was an independent determinant of future cardiac death or transplantation. In conclusion, complete LVRR is related to favorable prognosis in patients with idiopathic dilated cardiomyopathy. The extent of left ventricular reverse remodeling at 1 to 6 months after starting the therapy is predictive of long-term prognosis.
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Emphysema of any pathogenesis (nearly always chronic obstructive pulmonary disease) verticalizes the frontal P-wave axis >60° in adults, which, as a single criterion, has screened for obstructive pulmonary disease. In patients with emphysema, the QRS was of a significantly shorter duration than that in matched control patients. We investigated whether combining these 2 criteria would better detect or screen for emphysema. ⋯ In conclusion, a P axis >60° can be used alone with very high sensitivity and specificity to detect emphysema. The verticality of the P axis is usually immediately visible in the limb leads; therefore, this could be a rapid screening test for emphysema. The specificity was increased when combined with a shortened QRS duration, at the cost of the sensitivity.
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Decreased left ventricular (LV) longitudinal strain and increased circumferential LV strain have been demonstrated in patients with severe aortic stenosis (AS) and normal LV ejection fraction (LVEF). Biplane myocardial mechanics normalize after aortic valve replacement (AVR). This study objective was to examine LV mechanics before and soon after AVR in patients with AS and LV systolic dysfunction. ⋯ In conclusion, compensatory mechanisms (high circumferential strain in patients with preserved LVEF and increased apical rotation in patients with mild to moderate LV dysfunction) were observed in patients with severe AS. Compensatory mechanics were lost in patients with severe LV dysfunction. AVR partly reversed these changes in patients with LV dysfunction.
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Most patients presenting to the emergency department with possible cardiac symptoms have low cardiac troponin (cTn) concentrations. A combination of biomarkers that improves risk stratification in patients at very low risk for major adverse cardiovascular events (MACEs) would be beneficial. In this multicenter prospective cohort study, specimens from 598 subjects presenting to 5 emergency departments with suspected acute coronary syndromes were collected on arrival and serially for traditional and novel biomarkers. ⋯ Prognostic values of BNP and PlGF were incremental (none increased, 2 of 212, 0.9%; only PlGF increased, 30 of 170, 17.6%; only BNP increased, 33 of 153, 21.6%; BNP and PlGF increased, 18 of 86, 20.9%). Considering only initial emergency department samples, 97% and 96% of patients with normal PlGF, BNP, and cTnI levels were event-free at 30 and 365 days, respectively. In conclusion, the combination of BNP, PlGF, and eGFR is the most accurate in risk-stratifying patients with suspected acute coronary syndrome.