Cardiology
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Multicenter Study Comparative Study
Human heart-type fatty acid-binding protein as an early diagnostic and prognostic marker in acute coronary syndrome.
Although heart-type fatty acid-binding protein (H-FABP) can be a marker of sarcolemmal injury due to acute myocardial ischemia, the diagnostic or prognostic value is not established in patients with acute chest pain. This multicenter prospective study aimed to determine the diagnostic and prognostic values of H-FABP in 133 patients presenting to an emergency room with suspected acute coronary syndrome (ACS) by comparing with those of conventional biomarkers. ⋯ Receiver operating characteristics analysis revealed that H-FABP was the most reliable for detection of ACS and that H-FABP had the greatest sensitivities for identification of patients requiring emergency hospitalization, coronary angiography, and interventional therapy within 7 days among the biomarkers. Thus, H-FABP can be an early diagnostic and prognostic biochemical marker, particularly within the first 6 h from the onset of chest symptoms, in patients with chest pain at an emergency department.
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Comparative Study
Risk stratification of in-hospital mortality in patients hospitalized for chronic congestive heart failure secondary to non-ischemic cardiomyopathy.
The study population consisted of 234 consecutive patients hospitalized for acute exacerbation of congestive heart failure secondary to non-ischemic cardiomyopathy. Of the 234 patients, there were 55 in-hospital deaths. Their medical records were deliberatively reviewed and the association of 38 clinical, hemodynamic and biochemical variables with in-hospital mortality was evaluated by multiple stepwise logistic regression analysis. ⋯ In stratified analyses, the rates of in-hospital mortality rose rapidly as the number of risk factors increased: 0 risk factors, 2.5%; 1 risk factor, 5.1%; 2 risk factors, 36.4%; 3 risk factors, 75%, and no less than 4 risk factors, 100%. In conclusion, our study identified 6 variables that correlated with in-hospital death in patients with heart failure secondary to non-ischemic cardiomyopathy. The identification of these variables may allow more accurate risk stratification of individuals at risk of in-hospital mortality in this clinical setting.
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Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population. ⋯ In comparison with other life-saving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients' preference for quality rather than quantity of life, as expressed by the utility assumptions.
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To assess the short-term reliability of temporary epicardial pacing wires in patients after open heart surgery and to determine the influence of preoperative factors on the performance of these wires. ⋯ Although both atrial and ventricular temporary epicardial leads are reliable for short-term use, their function deteriorates on a daily basis. Perioperative factors are generally not helpful in predicting the performance of temporary epicardial pacing wires.
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Cellular mechanisms of adenosine include a direct effect on the activation of the adenosine-sensitive potassium current (I(K,Ado)) and an indirect effect on antagonism of catecholamine-stimulated adenylate cyclase activity. However, previous studies evaluating the influence of catecholamine activity on the electrophysiologic effects of adenosine have yielded conflicting results. We tested the hypotheses that if adenosine exerts its atrioventricular (AV) nodal blocking effects directly by activating the I(K,Ado) potassium current, rather than indirectly by reversing the catecholamine effects, then pretreatment with beta-adrenergic blockade would not potentiate the effects of adenosine in terminating AV nodal-dependent supraventricular tachycardia (SVT). ⋯ Intravenous esmolol infusion (up to 100 mg total dose) usually fails to terminate AV nodal-dependent SVT. In the esmolol-resistant tachycardia, esmolol pretreatment does not produce a positive synergistic effect on the efficacy of adenosine-induced termination of SVT. Therefore, in this tachycardia adenosine may exert its effects on AV nodal conduction directly by activation of the I(K,Ado) potassium current, rather than by antagonizing the beta-adrenergic system.