Cardiol J
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Syncope is a common and challenging presenting complaint to the Emergency Department (ED). Despite substantial research efforts, there is still considerable uncertainty about the optimal ED management of syncope. There is continued interest among clinicians and researchers in improving diagnostic algorithms and optimizing resource utilization. ⋯ For appropriate patients with a negative ED evaluation, we recommend consideration of direct discharge, with ambulatory monitoring and expedited follow-up, as a means of decreasing costs and reducing iatrogenic harms. Finally, we advocate for the use of shared decision-making regarding the ultimate disposition of select, intermediate risk patients who have not had a serious condition revealed in the ED. If properly implemented, these four strategies could significantly improve the care of ED syncope patients by helping clinicians identify truly high-risk patients, decreasing unnecessary hospitalizations, and increasing patient satisfaction.
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Review Meta Analysis
Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation.
Recent observational studies have shown that patients with chronic kidney disease (CKD) have higher risk of atrial fibrillation (AF) recurrence and, therefore, the value of catheter ablation therapy in patients with CKD has been doubted. The purpose of this meta-analysis was to systematically analyze the effect of CKD on recurrence of AF following catheter ablation. ⋯ CKD was associated with higher AF recurrence rate following single catheter ablation. In addition, patients with 100% paroxysmal AF have higher risk than patients with non 100% paroxysmal AF that merits special consideration when evaluating patients for catheter-based AF ablation. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of catheter ablation candidates.
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Multicenter Study
Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery.
Few studies have addressed the effect of "trainee surgeon" status on outcomes after isolated aortic valve replacement (AVR). ⋯ Isolated AVR can be safely and effectively performed by trainee surgeons who are strictly supervised in the operating theatre especially during the technically complex parts of the procedure.
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Multicenter Study
Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates.
Pulmonary hypertension is a contradiction for heart transplantation (HTx). The aim of the study was to examine prognostic significance of pulmonary hemodynamic variables in patients with severe chronic heart failure (HF) considered for HTx. ⋯ In patients qualified to HTx, pathological values of pulmonary hemodynamic parameters have a significant influence on survival. The worst prognosis have patients with PASP > 50 mm Hg, and PCWP > 25 mm Hg. Pulmonary hemodynamic parameters are important during allocation process to HTx.
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The purpose of this review was to summarize the up-to-date knowledge on clinical presentation and management of neurocardiogenic injury and to deliver the evidence of common pathophysiology of this broad spectrum of disorders. ⋯ Neurocardiogenic injury should be carefully differentiated from AMI. Cardiac dysfunction in SAH heralds increased mortality. The criteria for the diagnosis of stress cardiomyopathy should be revised to comprise the diversity of its clinical symptomatology and to include cardiac dysfunction accompanying cerebral pathology.