American heart journal
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American heart journal · Dec 2004
Clinical TrialPulsed wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction.
Assessment of left ventricular (LV) thrombosis risk after acute myocardial infarction (AMI) is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this study was to investigate whether early assessment of LV systolic and diastolic performance with pulsed wave tissue Doppler ultrasound scanning (PWTD) predicts LV thrombosis after AMI. ⋯ The MPI derived with PWTD soon after admission appears to be a useful parameter for assessing the risk of LV thrombosis after AMI. Patients with an MPI >0.6 after AMI seem to be at a higher risk for thrombus formation.
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American heart journal · Dec 2004
Impact of the choice of benchmark on the conclusions of hospital report cards.
Hospital report cards for outcomes following acute myocardial infarction (AMI) are being produced with increasing frequency. Implicit in the statistical methods used is the fact that hospitals are being compared with an average hospital. Prior research has demonstrated that institutional characteristics such as a high annual volume of AMI patients and academic status are associated with improved outcomes. This raises the important issue of what is an appropriate benchmark against which hospitals should be compared. The objective of the current study was to determine whether the number of hospitals identified as mortality outliers depended upon the benchmark against which hospitals are compared. ⋯ The use of peer-group-defined rather than overall benchmarks has a substantial impact on the identification of mortality outliers. The choice of the appropriate benchmark is related to the underlying purpose of the comparison.
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American heart journal · Dec 2004
Randomized Controlled Trial Comparative Study Clinical TrialMorbidity, mortality, physiologic and functional parameters in elderly and non-elderly patients in the Valsartan Heart Failure Trial (Val-HeFT).
The Valsartan Heart Failure Trial (Val-HeFT) demonstrated the favorable effects of the addition of valsartan to prescribed heart failure (HF) therapy on HF hospitalization, and functional and physiological parameters. As the prevalence of HF morbidity and mortality are increased in the elderly, the effect of valsartan in the elderly is of clinical significance. ⋯ Val-HeFT demonstrated that elderly patients present with more advanced HF as evidenced by higher morbidity and mortality along with greater neurohormonal activation. In Val-HeFT, valsartan produced a consistent beneficial effect on morbidity, LV function and size, quality of life, and neurohormonal levels in both the elderly and non-elderly.