American heart journal
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American heart journal · Mar 1994
Contribution of D-dimer plasma measurement and lower-limb venous ultrasound to the diagnosis of pulmonary embolism: a decision analysis model.
The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study has shown that clinical evaluation and lung scanning may substantiate or exclude pulmonary embolism with reasonable probability in approximately half of the patients in whom it is suspected; for the remainder, pulmonary angiography is considered the gold standard diagnostic test. We performed a decision analysis to assess the potential of two noninvasive tests, D-dimer plasma measurement and lower-limb B-mode venous ultrasound, for reducing the number of pulmonary angiograms necessary to diagnose pulmonary embolism. Our decision model addresses hypothetical patients in the emergency ward with suspected pulmonary embolism and abnormal lung scan results. ⋯ Pulmonary angiography should be performed when ultrasound is negative because of its presumably low sensitivity for deep venous thrombosis in patients with pulmonary embolism. A D-dimer measurement of less than 500 mu/L does not exclude pulmonary embolism in patients with a high clinical suspicion of pulmonary embolism. On the basis of the results of the PIOPED study, we calculated that the combination of D-dimer measurement and ultrasound might reduce the requirement for pulmonary angiography by one third among patients with inconclusive scan results and intermediate clinical probability of pulmonary embolism.
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American heart journal · Mar 1994
Evaluation of ventricular septal defect by transesophageal echocardiography: intraoperative assessment.
The miniaturization of transesophageal echocardiography (TEE) probes, together with the development of the capability for biplane imaging from the esophagus, have increased the use of TEE in pediatric cardiology. The aim of this study was to evaluate the TEE findings in patients with ventricular septal defect (VSD) before and after closure primarily by means of pediatric biplane probes. This study group included 69 patients who underwent VSD closure as an isolated repair or as a part of a definitive repair of a more complicated lesion. ⋯ Preoperative results: (1) anatomic findings: Two muscular VSDs were detected by matrix TEE but could not be observed by TTE. A patient with preoperative TTE diagnosis of an ostium primum ASD was found to have atrioventricular (AV) canal by TEE. In three of six AV canal type VSDs, both TTE and TEE demonstrated left ventricular-right atrial shunting (2) aortic regurgitation associated with VSD: Aortic regurgitation as a result of right coronary cusp prolapse was detected in one of five supracristal VSDs in which the biplane or matrix TEE was used.(ABSTRACT TRUNCATED AT 250 WORDS)
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American heart journal · Mar 1994
Comparative StudyImproved detection of transient myocardial ischemia by a new lead combination: value of bipolar lead Nehb D for Holter monitoring.
The investigations of ST-segment changes by Holter monitoring demonstrate asymptomatic and symptomatic episodes of myocardial ischemia, which may occur during daily activities. One factor, which is of great importance for the detection of silent myocardial ischemia during ambulatory monitoring, is the combination of the leads. Former studies showed that the analysis of two channels alone may not adequately detect silent myocardial ischemia. ⋯ The combination of leads CM2/CM5 and Nehb D raised the number of patients with documented ST-segment depressions to 33 of 54 (61%). Lead Nehb D showed the highest sensitivity for the detection of inferior wall ischemia (stenosis of the right coronary artery); nevertheless, this lead may not be regarded as specific for ST-segment alterations only caused by inferior wall ischemia. The correlation of ischemic ST-segment depressions during exercise testing (classified as anterior, inferior, or anterior and inferior type of ischemia) and documented ST-segment changes in the different Holter leads underline these results.(ABSTRACT TRUNCATED AT 250 WORDS)
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American heart journal · Feb 1994
Ventricular tachycardias of right ventricular origin: markers of subclinical right ventricular disease.
The diagnosis of subclinical myocardial disease in patients with ventricular tachycardias of right ventricular (RV) origin and no overt cardiac abnormalities is important, inasmuch as the presence of RV cardiomyopathy or arrhythmogenic dysplasia can be associated with a poor prognosis. To this end the relative value of symptoms, ECG features of ventricular tachycardia, signal-averaged ECGs, and RV echocardiograms as compared with endomyocardial biopsy findings was prospectively evaluated. Twenty-seven patients with chronic ventricular tachycardias with a left bundle branch block-like morphology, presumed to be of RV origin, were studied. ⋯ An abnormal RV echocardiogram was both a sensitive (73%) and a specific (94%) indicator of an abnormal RV biopsy. Sustained tachycardia although sensitive (90%) had a low specificity (56%). In comparison, a superior frontal plane axis of ventricular tachycardia and an abnormal signal-averaged ECG were indicative of high specificity and low sensitivity for abnormal myocardial histologic findings.(ABSTRACT TRUNCATED AT 250 WORDS)