Current medical research and opinion
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Background: Right but not left ventricular hemodynamic parameters have been found to be independently associated with adverse renal outcomes in patients with acute decompensated heart failure (HF). Aim: To investigate the hemodynamic profile of patients without acute decompensated heart failure and left ventricular ejection fraction >50% referred for elective left and right heart catheterization and to correlate left and right filling pressures, stroke volume and arterial blood pressure to renal function parameters. Subsequently, we tested the hypothesis that right ventricle and left ventricle hemodynamic parameters can predict all-cause mortality in our non-HF subjects. ⋯ Increased RAP (HR = 2.03; 95% [CI]: 1.05 to 3.9; p = .025) and age (HR = 1.08, 95% [CI] 1.04-1.12, p < .001) independently predicted all-cause mortality during follow up. Conclusions: Our study demonstrates that right ventricular preload affects renal function in patients with preserved systolic function and that neither aortic systolic pressure nor left ventricle pressure indices were related to estimated glomerular filtration rate. Furthermore, we demonstrate for the first time that an increased RAP is able to predict a worse prognosis in patients with preserved ejection fraction independently of well-established risk factors, such as blood pressure and SVI.
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Critical thinking is crucially important in both research and practice. This article demonstrates that a lack of critical thinking in two meta-analyses resulted in a conclusion that contradicts another meta-analysis and popular opinions. Kahwati et al. and Zhao et al. drew a conclusion that "Vitamin D supplementation alone or with calcium was not associated with reduced fracture incidence among community-dwelling adults without known vitamin D deficiency, osteoporosis, or prior fracture", which apparently contradicted that of Tang et al. ⋯ Subsequently, their conclusion was misleadingly interpreted by the public media as "Vitamin D and Calcium Don't Prevent Bone Fractures" and "Vitamin D Does Not Prevent Falls, Calcium Does Not Prevent Fractures-A $2 Billion Waste of Money". If study conclusions do not specify the applicable conditions, guidelines on medications, including supplements, are clinically unacceptable. Researchers must critically think about every step of their studies, including the way their conclusions are presented.