European heart journal
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European heart journal · Jul 1997
Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome.
The aim of the study was to determine the epidemiology of out-of-hospital cardiac arrests of non-cardiac origin and survival following resuscitation, using the Utstein method of data collection. ⋯ These results indicate that sudden out-of-hospital cardiac arrest more often has a non-cardiac cause than previously believed. Although survival is not as likely as from cardiac arrest of cardiac origin, since non-cardiac-cause survivors comprise one fifth of all out-of-hospital cardiac arrest survivors, resuscitation efforts are worthwhile.
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European heart journal · Jul 1997
The apical long-axis rather than the two-chamber view should be used in combination with the four-chamber view for accurate assessment of left ventricular volumes and function.
Most biplane methods for the echocardiographic calculation of left ventricular volumes assume orthogonality between paired views from the apical window. Our aim was to study the accuracy of biplane left ventricular volume calculations when either the apical two-chamber or long-axis views are combined with the four-chamber view. The left ventricular volumes calculated from three-dimensional echocardiographic data sets were used as a reference. Twenty-seven patients underwent precordial three-dimensional echocardiography using rotational acquisition of planes at 2-degree intervals, with ECG and respiratory gating. End-diastolic and end-systolic left ventricular volumes and ejection fraction on three-dimensional echocardiography were calculated by (1) Simpson's methods (3DS) at 3 mm short-axis slice thickness (reference method) and by (2) biplane ellipse from paired views using either apical four- and two-chamber views (BE-A) or apical four- and long-axis views (BE-B). Observer variabilities were studied by the standard error of the estimate % (SEE) in 19 patients for all methods. ⋯ Both apical two-chamber and apical long-axis views are not orthogonal to the apical four-chamber view. Observer variabilities of BE-B were smaller than that for BE-A. BE-A and BE-B have excellent correlation and non-significant differences with 3DS for left ventricular volume and ejection fraction calculations. There were closer limits of agreement between BE-B with 3DS for left ventricular volume and ejection fraction calculations than that between BE-A and 3DS. Therefore, we recommend the use of the apical long-axis rather than the two-chamber view in combination with the four-chamber view for accurate biplane left ventricular volume and ejection fraction calculations.
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European heart journal · Jun 1997
ReviewPrognostic value of dobutamine-atropine stress echocardiography for peri-operative and late cardiac events in patients scheduled for vascular surgery.
Cardiac events in the peri-operative phase and late after non-cardiac vascular surgery are a major cause of morbidity and mortality. Numerous tests and diagnostic strategies--usually consisting of a combination of analysis of clinical risk factors and additional non-exercise dependent stress testing, such as thallium scintigraphy, or stress echocardiography--have been developed to preoperatively identify patients with increased risk. The tests ideally should identify three subpopulations in a group with a high prevalence of coronary artery disease; (1) low-risk patients who can be referred for surgery without extra cardiac intervention. (2) patients whose peri-operative cardiac risk outweighs the potential benefits of vascular surgery, (3) patients whose risk may be reduced by peri-operative therapeutic interventions. This review will discuss the prognostic value of dobutamine stress echocardiography for risk stratification in patients scheduled for non-cardiac vascular surgery and discuss guidelines for future management.
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European heart journal · May 1997
ReviewUsing the right drug: a treatment algorithm for regular supraventricular tachycardias.
Despite the recent advent of and the successful results from catheter ablation, pharmacological therapy is still used by most clinicians as the first line therapy in patients with regular supraventricular tachycardias. Before prescribing an antiarrhythmic agent, documentation of the arrhythmia using a 12-lead electrocardiogram (ECG) is necessary to identify the type of tachycardia. The ECG diagnosis is based on the presence and polarity of the P wave, the P to QRS relationship, the presence of QRS alternation and the effect of bundle branch block on tachycardia rate. ⋯ In atrial tachycardias, the use of propafenone, flecainide or sotalol constitute a logical choice. In drug-resistant cases, amiodarone is the most potent agent. Radiofrequency ablation of the slow atrioventricular nodal pathway, of an accessory connection or of an atrial focus, is indicated in drug-resistant or drug-intolerant patients and is increasingly offered as an alternative therapy.
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European heart journal · Apr 1997
ReviewEffects of beta-blocker therapy on mortality in patients with heart failure. A systematic overview of randomized controlled trials.
Several randomized trials have reported that beta-blocker therapy improves left ventricular function and reduces the rate of hospitalization in patients with congestive heart failure. However, most trials were individually too small to assess reliably the effects of treatment on mortality. In these circumstances a systematic overview of all trials of beta-blocker therapy in patients with congestive heart failure may provide the most reliable guide to treatment effects. ⋯ Beta-blocker therapy is likely to reduce mortality in patients with heart failure. However, large-scale, long-term randomized trials are still required to confirm and quantify more precisely the benefit suggested by this overview.