International journal of cardiology
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Review Meta Analysis
Multi-detector computerized tomography angiography for evaluation of acute chest pain--a meta analysis and systematic review of literature.
Evaluation of pain localized to the chest in the emergency room is, challenging, time-consuming, costly, and often inconclusive. Available research, though limited, suggests a role for MDCTA in the evaluation of patients with acute chest pain of low to intermediate risk, for identifying and excluding ACSs during the initial emergency department evaluation. Accordingly, our aim was to conduct a meta-analysis to assess the diagnostic accuracy of MDCTA in this setting. ⋯ MDCTA has an excellent diagnostic accuracy in detection of significant coronary artery stenosis in patients with acute chest pain. This diagnostic accuracy of MDCTA has a potential for rapid triage of patients in the ED, with acute chest pain of low to intermediate risk of acute coronary syndrome, to rule out significant epicardial stenosis as the etiology of chest pain.
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The angiographic 'no-reflow' phenomenon after primary percutaneous coronary intervention (PPCI) is associated with a poor short-term and long-term clinical prognosis of ST-elevation myocardial infarction (STEMI). Although the increasing use of primary drug-eluting stent (DES) deployment for STEMI resulted in reduced adverse clinical outcomes, the prevalence of no-reflow has been unchanged. The purpose of our study was to evaluate the predictors for no-reflow for STEMI and identify such high-risk patients in the DES era. ⋯ Angiographic 'no-reflow' phenomenon after primary DES implantation for STEMI can be predicted by BNP levels on admission. BNP-guided approach may be useful in identifying patients at high risk of the no-reflow phenomenon after primary stenting.
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Red blood cell distribution width (RDW), a numerical measure of the variability in size of circulating erythrocytes, has recently been shown to be a strong predictor of adverse outcomes in patients with heart failure and in patients with prior myocardial infarction but no symptomatic heart failure at baseline, even after adjustment for hematocrit. However, there are no data in other cardiac populations, including patients with acute coronary syndromes (ACS). ⋯ These data demonstrate that elevated RDW is a strong and independent predictor of all-cause mortality in an unselected population of male patients across a broad spectrum of risk (including ACS) referred for coronary angiography.
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Comparative Study
The relationship between tumor necrosis factor-α, brain natriuretic peptide and atrial natriuretic peptide in patients with chronic heart failure.
Cytokines such as tumor necrosis factor-alpha (TNF) contribute to cardiac dysfunction in chronic heart failure (CHF). Brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) are thought to reflect cardiac functional and structural damage. ⋯ In CHF, TNF is closely related to BNP and ANP (independently of CHF severity and ventricular dysfunction), particularly in patients with cardiac cachexia. TNF may causally contribute to intrinsic cardiac dysfunction thereby stimulating BNP and ANP secretion.