The Canadian journal of cardiology
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Comparative Study
Prediction of in-hospital mortality by brain natriuretic peptide levels and other independent variables in acutely ill patients with suspected heart disease.
Brain natriuretic peptide (BNP) measurement can detect and assess heart failure. However, compared with traditional clinical parameters, its value for predicting the in-hospital mortality of patients with suspected heart disease has not been reported. ⋯ Five independent variables (hypotension, anemia, leukocytosis, prior illness and elevated BNP levels) are comparable predictors of in-hospital mortality in patients with suspected heart disease.
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The use of ventricular assist devices as a 'bridge to recovery' has a lot to promise. However, we are at a stage where there are more questions than answers. It is still difficult to predict who will be the right candidate and who will have sustained recovery after explantation of the device. ⋯ A case that was successfully bridged to recovery with a left ventricular assist device is presented, together with a discussion of the literature. The search for precise markers of recovery should continue and a multicentre prospective study to validate weaning protocols is needed. At present, one should consider all available markers and look at the full clinical picture before allocating a patient to a bridge to recovery destination.
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Renal failure following heart transplantation carries a poor prognosis. The objectives of this study were to determine risk factors for renal failure requiring continuous renal replacement therapy (CRRT), to describe the management strategies regarding immunosuppressive therapy and to examine the short-term prognosis. ⋯ Creatinine clearance is an important predictor of renal failure requiring renal replacement therapy. Although renal failure remains a serious complication after transplantation, the use of CRRT and antilymphocyte agents during cyclosporine A withholding is associated with a favourable short-term prognosis following heart transplantation.
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A patient with hypertrophic obstructive cardiomyopathy developed mitral regurgitation due to infective endocarditis. The patient, a 29-year-old man with a 16-year history of a severe obstructive form of hypertrophic obstructive cardiomyopathy (left ventricular outflow gradient more than 100 mmHg), was admitted with bacteremia. ⋯ Postoperative echocardiography revealed that the left ventricular outflow gradient had decreased to 15 mmHg. Ten months after the combined operation, the patient was well and asymptomatic.