ABSTRACT
Right ventricular systolic dysfunction (RVSD) has been related to prognosis in patients with heart failure (HF) and/or left ventricular systolic dysfunction. However, most of the studies addressing this issue are not large enough, have different inclusion criteria, and use different methods to evaluate RV function to draw definite conclusions. We sought to investigate the association between RVSD and outcomes in patients with left ventricular dysfunction. Eleven studies of 40 (27.5%), with 4732 patients, were included in the meta-analysis. RVSD was present in 2234 patients (47.2%). Four of the studies had admission for HF as an endpoint. We found a significant association between RVSD and overall mortality with significant between-studies heterogeneity and presence of publication bias (funnel plot). A significant association was found between RVSD and admission for HF. RVSD is associated with overall mortality and admission for HF during follow-up. Significant between-studies heterogeneity and publication bias must be taken into account when interpreting this information.
Subject(s)
Heart Failure/mortality , Ventricular Dysfunction, Right/mortality , Ventricular Function, Right , Chi-Square Distribution , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Failure/therapy , Humans , Odds Ratio , Patient Admission , Prognosis , Risk Assessment , Risk Factors , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/therapy , Ventricular Function, LeftABSTRACT
OBJECTIVES: To determine the frequency of urgent coronary angiography in patients with acute pericarditis and to examine clinical characteristics associated with coronary angiography. PATIENTS AND METHODS: This is a retrospective analysis of all incident cases of acute viral or idiopathic pericarditis evaluated at Mayo Clinic's site in Rochester, MN, between January 1, 2000, and December 31, 2006. The main outcome measures were use of urgent coronary angiography and rate of concomitant coronary artery disease in patients with pericarditis. RESULTS: There were 238 patients with a final diagnosis of acute pericarditis (mean age, 47.7+/-17.9 years; 157 [66.0%] were male). On the initial electrocardiogram, 146 patients (61.3%) had ST-segment elevation, and 92 (38.7%) had no ST-segment elevation. Coronary angiography was performed in 40 patients (16.8% of all patients); the frequency was 5-fold higher among those with ST-segment elevation (24.7% vs 4.3%; P<.001). Additionally, 7 patients (4.8%) with ST-segment elevation received thrombolytics before transfer to our institution; no patients without ST-segment elevation received thrombolysis (P=.05). Characteristics associated with a higher likelihood of coronary angiography included typical anginal chest pain, ST-segment elevation, previous percutaneous coronary intervention, elevated troponin T values, diaphoresis, and male sex. Coronary angiography revealed concomitant mild to moderate coronary artery disease in 14 (35.0%) of the 40 patients who underwent this procedure. CONCLUSION: Urgent coronary angiography is commonly performed in patients with acute pericarditis, particularly those with ST-segment elevation, typical myocardial infarction symptoms, and elevated troponin T values. Coronary artery disease was present angiographically in one-third of patients undergoing the procedure. Although patients with ST-segment elevation myocardial infarction must receive prompt reperfusion, clinicians must also consider the diagnosis of pericarditis to avoid unneeded coronary angiography.
Subject(s)
Coronary Angiography/statistics & numerical data , Emergencies , Pericarditis/diagnostic imaging , Acute Disease , Coronary Disease/diagnosis , Diagnosis, Differential , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesABSTRACT
Introducción y objetivos. La presencia de angina preinfarto (AP) reduce el tamaño de la necrosis miocárdica e induce más cantidad de miocardio viable y una mejor función ventricular izquierda. Sin embargo, la asociación entre mortalidad y AP es controvertida. El objetivo de este estudio fue determinar si la AP se asocia con la mortalidad intrahospitalaria. Método. Se realizó un metaanálisis (modelo de efectos fijos) de los estudios publicados hasta el momento en los que se analiza la mortalidad intrahospitalaria de pacientes con infarto agudo de miocardio según presenten o no AP, definida como la que acontece en las 24 h previas al comienzo del infarto. A partir de las bases de datos MEDLINE y EMBASE se realizó una búsqueda en junio de 2004 con los términos «preinfarction angina or prodromal angina and mortality» y se incluyeron finalmente 6 trabajos, con un total de 3.497 pacientes. Resultados. En sólo uno de los estudios se encuentra una asociación beneficiosa estadísticamente significativa entre AP y mortalidad intrahospitalaria. Tras agrupar los datos se encontró una reducción significativa en la probabilidad de muerte intrahospitalaria en pacientes con AP (odds ratio = 0,61; intervalo de confianza del 95%, 0,48-0,78; p < 0,0001). No se encontró heterogeneidad significativa entre los estudios (χ² = 5,92; p = 0,31). Conclusiones. La presencia de angina en las 24 h previas al inicio del infarto de miocardio se asocia con una reducción significativa de la mortalidad intrahospitalaria del 39% (AU)
Introduction and objectives. The occurrence of preinfarction angina (PA) reduces the extent of myocardial necrosis, increases the volume of viable myocardium, and improves left ventricular function. However, there is no agreement about the effect of PA on mortality. The objective of this study was to determine whether PA is associated with in-hospital mortality. Method. A meta-analysis (fixed effects model) of all published reports evaluating in-hospital mortality in patients with acute myocardial infarction according to the presence or absence of PA was performed. PA was defined as the occurrence of angina in the 24 hours before onset of the infarction. We searched the Medline and Embase databases in June 2004 using «preinfarction angina or prodromal angina and mortality» as search terms. Six studies involving a total of 3497 patients were finally identified. Results. Only one study reported that PA had a statistically significant beneficial effect on in-hospital mortality. However, combining the data showed that the presence of PA was associated with a significant decrease in the probability of in-hospital death (odds ratio=0.61; 95% CI: 0.48-0.78; P<.0001. We did not detect any significant heterogeneity between the studies (χ⊃2;=5.92; P=.31). Conclusions. The occurrence of preinfarction angina in the 24 hours before the onset of myocardial infarction was associated with a significant reduction in in-hospital mortality of 39% (AU)
