The American journal of cardiology
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Forty-six consecutive patients with pulmonary embolism (PE) who underwent pulmonary angiography, helical computed tomography (CT), and echocardiography in the investigators' emergency department were studied. It was determined that the CT right ventricular (RV)/left ventricular (LV) end-diastolic area ratio was correlated with PE obstruction and echocardiography. A CT RV/LV area ratio >1 had a sensitivity of 88% and a specificity of 88% in diagnosing significant PE. The present study suggests that helical CT may be used as a triage tool in acute PE for selecting high-risk patients, using calculation of the RV/LV area ratio to detect RV dysfunction.
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Comparative Study Clinical Trial
Usefulness of enalapril versus propranolol or atenolol for prevention of aortic dilation in patients with the Marfan syndrome.
Despite variable clinical results, beta blockers have become the primary therapy for prevention of aortic dilation in patients with the Marfan syndrome. This study examines the use of the angiotensin-converting enzyme inhibitor enalapril for treatment of these patients. We sought to examine the effects of enalapril versus beta-blocker therapy in patients with the Marfan syndrome and noted improved aortic distensibility (3.0 +/- 0.3 vs 1.9 +/- 0.4 cm2 dynes(-1); p <0.02) and a reduced aortic stiffness index (8.0 +/- 2.9 vs 18.4 +/- 3.8; p <0.05) in patients receiving enalapril compared with those receiving beta blockers. These favorable hemodynamic changes were associated with a smaller increase in aortic root diameter (0.1 +/- 1.0 vs 5.8 +/- 5.2 mm) and fewer clinical end points during follow-up.
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Clinical Trial
The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study.
The utility of aminoterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department to rule out acute congestive heart failure (CHF) and the optimal cutpoints for this use are not established. We conducted a prospective study of 600 patients who presented in the emergency department with dyspnea. The clinical diagnosis of acute CHF was determined by study physicians who were blinded to NT-proBNP results. ⋯ Increased NT-proBNP was the strongest independent predictor of a final diagnosis of acute CHF (odds ratio 44, 95% confidence interval 21.0 to 91.0, p <0.0001). NT-proBNP testing alone was superior to clinical judgment alone for diagnosing acute CHF (p = 0.006); NT-proBNP plus clinical judgment was superior to NT-proBNP or clinical judgment alone. NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting.
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This study assessed whether a gender gap exists in therapy, procedure use, and outcomes in patients who have a new diagnosis of congestive heart failure (CHF) at the population level. The Quebec hospital discharge database was linked with the physician and drug claims databases to identify a cohort of patients who had a diagnosis of CHF (code 428 in the International Classification of Diseases, Ninth Revision) between January 1998 and December 2002. There were 16,017 men and 16,622 women. ⋯ Women and men had similar yearly numbers of rehospitalizations for CHF (1.4 +/- 1.0 vs 1.5 +/- 1.0) and emergency room visits (1.7 +/- 1.2 vs 1.8 +/- 1.3). The adjusted risk of death was minimally higher in men than in women (hazard ratio 1.06, 95% confidence interval 1.03 to 1.1, p <0.01). Thus, despite less frequent cardiologist assessment, fewer cardiac-related procedures, and less frequent use of standard medical therapy, clinical outcomes in women and men who had CHF were similar.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of cilostazol and clopidogrel after successful coronary stenting.
This study compared the safety and efficacy of cilostazol and clopidogrel after coronary stenting. Patients (n = 689) who underwent successful stenting were randomly assigned to receive cilostazol (group 1, n = 344, 612 lesions) or clopidogrel (group 2, n = 345, 628 lesions). The incidence of subacute stent thrombosis or major adverse cardiac events, including death, myocardial infarction, and target lesion revascularization within 30 days (2.6% in group 1 vs 2.0% in group 2, p = 0.61) and side effects that required cessation of study drug (0.6% each) did not differ statistically between groups. These results indicate that cilostazol is as safe and effective as clopidogrel in preventing thrombotic complications after stenting.