International journal of cardiology
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Randomized Controlled Trial
The use of B-type natriuretic peptide in the management of patients with atrial fibrillation and dyspnea.
The utility of B-type natriuretic peptide (BNP) testing in patients with atrial fibrillation (AF) is poorly defined. We analyzed patients (n=452) included in the BNP for Acute Shortness of Breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with or without the use of BNP. ⋯ Initial total treatment costs (median) were $4239 [769-7422] in the BNP group and $5940 [4024-10848] in the control group (P=0.041). These benefits were maintained after 90 days: patients in the BNP group had spent fewer days in hospital (10 days [2-21] versus 15 days [IQR 9-27]; P=0.022) and induced lower total treatment costs ($4790 [1260-9387] versus $7179 [4311-13173]; P=0.016). In conclusion, the use of BNP seems to improve the management of patients with AF presenting with dyspnea.
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Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure. ⋯ E/(EaxSa)(average) was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/Ea(average) between 8 and 15 and in those with regional dysfunction.
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Randomized Controlled Trial Comparative Study
Effects of intracoronary compared to intravenous abciximab administration in patients undergoing transradial percutaneous coronary intervention: A sub-analysis of the EASY trial.
In the EASY trial, we have shown the clinical equivalence between abciximab bolus-only and abciximab bolus followed by 12-h infusion in a wide spectrum of patients after percutaneous coronary intervention (PCI). Some reports have suggested better outcomes following intracoronary (IC) abciximab administration compared to intravenous (IV) delivery. We sought to compare cardiac biomarkers release and early and late clinical outcomes after IC or IV abciximab bolus delivery. ⋯ Compared to IV abciximab administration, IC abciximab was not associated with less cardiac biomarkers release or better clinical outcomes after uncomplicated transradial PCI. Further studies are required in clinical scenarios including patients with higher thrombotic burden and/or occluded vessels as in primary and rescue PCI.
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Letter Case Reports
The use of Levosimendan for myocardiopathy due to acute Chagas' disease.
Acute Chagas' disease corresponds to the initial period of a Trypanosoma cruzi infection. Levosimendan is a positive inotropic drug with vasodilatory properties that is indicated for acute heart failure. ⋯ Both developed acute decompensated heart failure refractory to Dobutamine. We describe for the first time in the medical literature the use of Levosimendan for myocarditis due to acute Chagas' disease, with excellent clinical and hemodynamic results.