ABSTRACT
BACKGROUND/AIMS: Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of postoperative cardiovascular complications. The present study investigated whether blood NT-proBNP values are suitable for predicting postoperative cardiovascular complications after non-cardiac surgery in elderly patients showing normal left ventricular (LV) function on preoperative echocardiograms. METHODS: This study was performed by analyzing the medical records of elderly patients referred to the cardiology department for the purpose of assessing their cardiac function before orthopedic surgery. Of the patients who underwent echocardiography and NT-proBNP assessment simultaneously, 275 patients aged > or = 70 years and with an LV ejection fraction of > or = 55% were included in the study. RESULTS: Major adverse cardiac and cerebrovascular events (MACCEs) occurred in 33 (12%) of the 275 patients, and the NT-proBNP concentration was higher in patients with complications than in those without complications (1,904.20 +/- 2,300.23 vs. 530.58 +/- 882.27 pg/mL, p 80 years (odds ratio, 2.313; p = 0.047) and an increased blood NT-proBNP concentration (odds ratio, 3.189; p = 0.009) were independent risk factors for the prediction of MACCEs. CONCLUSIONS: Although elderly patients scheduled to undergo non-cardiac surgery may show normal LV systolic function on echocardiography, measurement of their preoperative blood NT-proBNP concentration is useful for predicting MACCEs occurring after non-cardiac surgery.
Subject(s)
Aged , Humans , Cardiology , Echocardiography , Medical Records , Multivariate Analysis , Natriuretic Peptides , Orthopedics , Risk FactorsABSTRACT
Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.
Subject(s)
Angioplasty, Balloon, Coronary , Cardiac Tamponade , Coronary Vessels , Drainage , Drug-Eluting Stents , Heart Arrest , StentsABSTRACT
To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
Subject(s)
Humans , Emergencies , Emergency Service, Hospital , Patient Care , Pelvis , Radiation, Ionizing , Radiography, Thoracic , SpineABSTRACT
BACKGROUND: The prognosis of patients with dilated cardiomyopathy remains poor. Doppler echocardiography and cardiac iodine-123-metaiodobenzylguanidine(MIBG) myocardial scintigraphy are useful non-invasive diagnostic modalities to assess the prognosis in these patients. However, the relationship between myocardial MIBG uptake and Doppler echocardiographic. variables was not well investigated. We analyzed the cardiac MIBG imaging in 40 patients with dilated cardiomyopathy and assessed the correlation between the echocardiographic parameters and myocardial MIBG uptake. MIBG uptake(DHM), assessed as the heart/mediastinum ratio measured on anterior view image obtained 4 hours after injection, was compared with M-mode(left ventricular end-diastolic dimension, left ventricular ejection fraction) and Doppler parameters. RESULTS: 1) Early and delayed MIBG uptake of heart were significantly lower in patient group compared with normal control subjects. There were no significant differences in lung and mediastinum uptake of MIBG between the two groups. 2) Early and delayed MIBG uptake ratios of the heart to lung and heart to mediastinum were significantly lower in patient group compared with those of normal control subjects. 3) DHM was significantly lower in patients with NYHA functional class 3, 4 than those with NYHA functional class 1, 2 in patient group. There was, however, no significant difference of DHM in patient group divided by the degree of mitral regurgitation and left ventricular diastolic filling pattern. 4) There were no significant correlations between DHM and other prognostic factors(left ventricular end-diastolic dimension, left ventricular ejection fraction, peak velocity of early diastolic filling(E velocity), deceleration time of E wave, cardiac output, pulmonary capillary wedge pressure, left ventricular end-diastolic pressure and 24hr urine norepinephrine). CONCLUSION: Iodine-123-MIBG scan is a useful noninvasive imaging modality in the assessment of cardiac sympathetic neuronal integrity in patients with dilated cardiomyopathy. There were no significant correlations between cardiac MIBG uptake and other prognostic factors. The cardiac MIBG uptake probably can be utilized as an independent prognostic factor, hence it would be suggested that a large prospective clinical study is needed to consolidate these findings.
Subject(s)
Humans , 3-Iodobenzylguanidine , Cardiac Output , Cardiomyopathy, Dilated , Deceleration , Echocardiography , Echocardiography, Doppler , Heart , Lung , Mediastinum , Mitral Valve Insufficiency , Myocardial Perfusion Imaging , Neurons , Prognosis , Pulmonary Wedge Pressure , Stroke VolumeABSTRACT
No abstract available.
Subject(s)
Humans , Hypertension , Kidney Failure, Chronic , Renal InsufficiencyABSTRACT
No abstract available.
Subject(s)
Humans , Hypertension , Kidney Failure, Chronic , Renal InsufficiencyABSTRACT
To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, electrocardiographic findings in 51 consecutive patients with acute inferior myocardial infarction were analysed with clinical findings and coronary artery angiography. Thirty patients(Group A) had no or or =1.0mm ST depression in two or more precordial(VI-6) leads were included in this study. Patients in Group B thd greater summed ST-segment elevation in leads II, III, AVF(6.3+/-6.1 vs 2.4+/-2.3mm, p<0.05), higher plasma peak CK levels(1776.8+/-1503.3 vs 5666.6+/-587.7 IU/L, p<0.05), higher plasmal peak CK-MB levels(141.2+/-1553.3 vs 34.1+/-35.7 IU/L, p<0.05), more prevalence of proximal left anterior descending coronary artery disease (46.6% vs 16.6%, p<0.05) than patients in Group A. There was no significant difference between Group A and Group B in the LV ejection fraction, delta area decreasing rate, infarction related asynergy, complications during hospitalization and cardiac events during follow up period. In conclusion, patients with acute inferior myocardial infarction who have associated with precordial ST depression had more extensive myocardial damage probably due to concomitant left anterior descending coronary artery disease.