The American journal of cardiology
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Limited data have been published on the use of external defibrillators that deliver impedance compensated biphasic (ICB) waveforms in patients. We compared 2 ICB defibrillators, the Heartstream XL (150-150-150 J protocol) and Heartsine Samaritan (100-150-200 J protocol) in 78 consecutive patients in cardiac arrest. ⋯ By the third shock, the Heartsine Samaritan had significantly better performance in removing ventricular fibrillation (p = 0.029). Energy selection for ICB waveforms requires further validation.
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Comparative Study
Utility and diagnostic accuracy of hand-carried ultrasound for emergency room evaluation of chest pain.
This study examined the utility and accuracy of immediate hand-carried echocardiography in patients presenting to the emergency room with chest pain and a normal or nondiagnostic electrocardiogram. Hand-carried echocardiography was highly concordant (kappa = 0.8) with troponin T tests as well as the discharge diagnosis of acute coronary syndrome, had a 100% sensitivity for the detection of acute coronary syndrome, 93% specificity, and 71% and 100% positive and negative predictive values, respectively.
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To identify the incidence of pericardial effusion in patients after cardiac surgery using a hand-carried cardiac ultrasound device, 200 patients were assessed on postoperative day 3. If a pericardial effusion was found, patients were monitored for 3 consecutive days with a hand-carried cardiac ultrasound device. ⋯ No difference was found in the incidence of effusion based on the type of cardiac surgery. Of patients with a small pericardial effusion on day 3 after surgery, an additional 2 of 41 (5%) developed cardiac tamponade.
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Comparative Study
Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention.
Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI. ⋯ Contrast-induced nephropathy was independently predicted (all p <0.0001) by peri-PCI hypotension (odds ratio [OR] 2.62), insulin treatment (OR 1.84), and volume of contrast medium (OR 1.30). The 1-year mortality rate was strikingly higher (all p <0.0001) in patients with CKD who did not receive dialysis (16%) and those on dialysis (44%) compared with the group with preserved renal function (5%). Contrast-induced nephropathy was among the independent predictors of a 1-year mortality rate (OR 2.75, p <0.001).
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This study evaluated the influence of coronary artery bypass grafting on heart rate turbulence (HRT) parameters assessed during 1-year follow-up in patients with coronary artery disease. HRT and heart rate variability (HRV) parameters significantly worsened 3 months after surgery. ⋯ Our results show that there is a marked attenuation of HRT parameters in the early postoperative period, indicating an impairment of baroreflex sensitivity after coronary artery bypass grafting. Concomitant depression of HRV parameters points to dysfunction of the autonomic nervous system, provoked by perioperative attenuation, as a potential underlying cause of impaired baroreflex response.