Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Jan 2013
ReviewAlternative approach to improving survival of patients with out-of-hospital primary cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) is a common cause of death. In spite of recurring updates of guidelines, the survival of patients with OHCA was essentially unchanged from the mid 1970s to the mid 2000s, averaging 7.6% for all OHCA and 17.7% for OHCA due to ventricular fibrillation. In the past, changes in one's approach to resuscitation had to await the semi-decennial publications of guidelines. ⋯ Using cardiocerebral resuscitation as a model for CQI, neurologically intact survival of patients with OHCA in ventricular fibrillation improved in 2 rural counties in Wisconsin, from 15% to 39%, and in 60 emergency medical systems in Arizona, to 38%. By advocating chest compression only CPR for bystanders of patients with primary OHCA and encouraging the use of cardiocerebral resuscitation by emergency medical systems, survival of patients with primary cardiac arrest in Arizona increased over a 5-year period from 17.7% to 33.7%. We recommend that all emergency medical systems determine their baseline survival rates of patients with OHCA and a shockable rhythm, and consider implementing the CQI approach if the community does not have a neurologically intact survival rate of at least 30%.
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J. Am. Coll. Cardiol. · Jan 2013
Simvastatin effects on skeletal muscle: relation to decreased mitochondrial function and glucose intolerance.
Glucose tolerance and skeletal muscle coenzyme Q(10) (Q(10)) content, mitochondrial density, and mitochondrial oxidative phosphorylation (OXPHOS) capacity were measured in simvastatin-treated patients (n = 10) and in well-matched control subjects (n = 9). ⋯ These simvastatin-treated patients were glucose intolerant. A decreased Q(10) content was accompanied by a decreased maximal OXPHOS capacity in the simvastatin-treated patients. It is plausible that this finding partly explains the muscle pain and exercise intolerance that many patients experience with their statin treatment.
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J. Am. Coll. Cardiol. · Jan 2013
Comparative StudySex differences in arterial stiffness and ventricular-arterial interactions.
This study sought to assess sex differences in ventricular-arterial interactions. ⋯ Proximal aortic stiffness (Z(c)) is greater in women than men, and women may be more susceptible to the deleterious effects of greater pulsatile and early arterial load on diastolic function and ventricular-arterial interaction. This may contribute to the greater risk of heart failure with preserved ejection fraction in women.
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J. Am. Coll. Cardiol. · Jan 2013
Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy.
The aim of this study was to identify the best echocardiographic method for sequential quantification of left ventricular (LV) ejection fraction (EF) and volumes in patients undergoing cancer chemotherapy. ⋯ Noncontrast 3DE was the most reproducible technique for LVEF and LV volume measurements over 1 year of follow-up.