American heart journal
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American heart journal · Jan 2010
Comparative StudyPredictive value of B-type natriuretic peptides in detecting latent left ventricular diastolic dysfunction in beta-thalassemia major.
Beta-thalassemia major is a unique disease characterized by early diastolic dysfunction, related exclusively to iron myocardial deposition. N-terminal-proBNP(amino-terminal) (NT-proBNP) and B-type natriuretic peptide (BNP) are sensitive biomarkers for the detection of asymptomatic left ventricular (LV) dysfunction, and they have important diagnostic and prognostic implications. Using beta-thalassemia as a model disease with isolated diastolic dysfunction, we sought to investigate the predictive value of NT-proBNP and BNP levels in comparison with the conventional and new Doppler echocardiography indexes in detecting this disorder. ⋯ BNP and NT-proBNP levels are significantly increased in documented left ventricular diastolic dysfunction, while NT-proBNP seems to have better predictive value in detecting latent left ventricular diastolic dysfunction in beta-thalassemia major.
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American heart journal · Jan 2010
Review Comparative StudyPercutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease?
Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used in patients with CS with multivessel coronary disease, the optimal revascularization strategy in this setting remains unknown. ⋯ Limited data from observational studies in patients with CS and multivessel disease suggest that CABG should be considered a complementary reperfusion strategy to PCI and may be preferred, especially when complete revascularization with PCI is not possible. Our data highlight the need for large randomized trials to further evaluate the relative benefit of PCI versus CABG in patients with multivessel coronary disease and CS using contemporary surgical and percutaneous techniques.
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American heart journal · Jan 2010
Randomized Controlled Trial Comparative StudySafety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction--a prospective and randomized trial in low-risk primary percutaneous coronary intervention patients (the Safe-Depart Trial).
Patients with ST-segment elevation myocardial infarction (STEMI) have traditionally been hospitalized for 5 to 7 days to monitor for serious complications such as heart failure, arrhythmias, reinfarction, and death. The Zwolle Primary Percutaneous Coronary Intervention (PCI) Index is an externally validated risk score that has been used to identify low-risk STEMI patients who have undergone primary PCI and can safely be discharged from hospital within 72 hours. Previous studies have shown that many low-risk patients remain in hospital significantly longer. ⋯ In low-risk STEMI patients treated with primary or rescue PCI, a strategy of early hospital discharge facilitated by close nursing follow-up is feasible. Although our study did not identify differences in compliance or quality of life between the 2 groups, it did provide a functional study design for a larger trial powered to detect these important clinical end points.
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American heart journal · Jan 2010
Comparative StudyAssociation of longitudinal measures of hemoglobin and outcomes after hospitalization for heart failure.
Cross-sectional assessments of hemoglobin (Hb) are associated with mortality in patients with heart failure (HF). Our objectives were to characterize patterns of change in Hb over time in patients with HF and to evaluate the relationship between longitudinal measures of Hb and adverse outcomes. ⋯ Variability in Hb over time is common in patients with HF, and declining Hb is associated with a poor prognosis. Longitudinal characterization of Hb levels has greater prognostic significance than a single measurement. Systematic surveillance of Hb levels may help identify high-risk patients with heart failure.
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American heart journal · Jan 2010
Randomized Controlled Trial Comparative StudyPlasma N-terminal fragment of the prohormone B-type natriuretic peptide concentrations in relation to time to treatment and Thrombolysis in Myocardial Infarction (TIMI) flow: a substudy of the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT IV-PCI) trial.
We investigated the prognostic significance of plasma N-terminal fragment of the prohormone B-type natriuretic peptide (Nt-proBNP) concentrations in addition to time to reperfusion and Thrombolysis in Myocardial Infarction (TIMI) flow before and after coronary intervention in patients with ST elevation myocardial infarction (STEMI) from the database of the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT IV-PCI) trial. ⋯ Elevated plasma concentrations of Nt-proBNP in the early phase of STEMI determine in-hospital and 90-day outcome after infarction irrespective of time to treatment and pre- or postinterventional TIMI flow.